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I 

THREE  lilNDRED  AND  EIGHTY-FOUR 


LAIi^EOTOMIES 


Various   diseases, 


WITH    TABLES    SHOWING    THE     RESULTS     OF     THE     OPERATIONS 

AND    THE     SUBSEQUENT     HISTORY    OF    THE    PATIENTS. 

A    RESUME    OF    THE    WRITEr's    EXPERIENCE    IN 

ABDOMINAL    SURGERY    DURING    THE 

LAST    FIFTEEN    YEARS. 


JOHN   ROMANS,  M.  D., 

HARVARD    UNIVERSITY    CLINICAL    INSTRUCTOR    IN    THE    niAGNObIS    AND    TREATMENT 
OF    OVARIAN    TUMORS.      SURGEON   TO    THE    MASSACHUSETTS    GENERAL    HOSPITAL. 


BOSTON: 

NATHAN   SAWYER  &.  SON,  PRINTERS, 
No.    70     State     Street. 

1887. 


ERRATA. 

On  page  6,  eighth  line  from  foot,  strike  out  word 
"  respectively." 

In  head  line  of  table  "  Laparotomy  for  other  purposes 
than  the  removal  of  Abdominal  Tumors,"  strike  out  the 
word  "Abdominal"  and  insert  "Ovarian." 


Digitized  by  tine  Internet  Arciiive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/threehundredeighOOhoma 


CHAPTER   I. 

GENERAL  METHOD  PURSUED    IX    PREPARING  FOR    LAPAR- 
OTOMY.      SOME    STATISTICAL  ACCOUNT  OF  RESULTS. 

The  Laparotomies  enumerated  in  the  accompanying 
tables  have  been  carefully  tabulated,  and  the  preparation 
of  these  tables  has  required  much  correspondence  and 
hard  work.  I  have  looked  through  the  tables  and  have 
picked  out  cases,  here  and  there,  which  seemed  to  me 
to  be  of  special  interest,  and  where  the  usefulness  of  a 
rather  minute  description  of  the  case  and  its  treatment 
seemed  to  require  it  I  have  given  a  full  narration. 

In  what  I  have  to  say  I  will  confine  myself  wholly  to 
mv  own  experience,  without  theorizing  or  quoting  au- 
thorities. I  do  not  do  this  in  a  narrow,  egotistical  way, 
but  because  all  of  you  have  read  and  heard  all  that  I 
have  read  or  heard,  and  need  not  be  bored  by  hearing 
the  statements  and  theories  of  others  at  second-hand. 

384  Laparotomies.  Of  these.  Ovariotomies  number 
2S2.  Removal  of  Uterine  Tumors,  27.  Simple  Ex- 
ploratory Laparotomies,  19.  Laparotomies  and  stitch- 
ing of  Ovarian  Cvsts  to  the  skin,  15.  Removal  of 
uterine  appendages  for  Fibro-myoma,  5.  Removal  of 
uterine  appendages  for  nervous  disorders,  5.  Pyosal- 
pinx,  I.  Tubo-ovarian.  i.  Abdominal  Abscess,  i. 
Removal  of  immense  Lipomas,  2.  Intestinal  obstruc- 
tion, 4.     Renal  Tumor,  3.     Perityphlitic  Abscess,  i. 

I  have  alwavs  regarded  Sir  Spencer  Wells's  first 
volume  of  Cases  of  Ovariotomy,  published  about  1865, 
as  the  most  valuable  book  for  a  beginner  to  study. 


In  a  very  humble  wa}',  perhaps,  this  paper  and  these 
tables  may  be  of  interest  to  the  student  and  practitioner 
of  abdominal  surgery.  I  have  been  rather  surprised  to 
find  that  thirty  women  out  of  over  three  hundred,  or 
nearly  ten  per  cent.,  have  ventral  hernia. 

The  general  method  I  have  pursued  in  preparing  for 
a  Laparotomy  is  the  following  : 

I  have  a  sufficient  number  (say  six  or  eight)  earthen- 
ware jars,  such  as  we  use  in  New  England  for  holding 
pickles,  each  of  which  will  contain  six  gallons  of  fluid  ; 
two  or  more  of  them  are  filled  with  a  solution  of  corro- 
sive-sublimate i-iooo ;  new  sponges  are  cleansed  of 
their  sand  and  are  put  to  soak  in  the  bi-chloride  solution, 
and  left  there  two  or  more  days  ;  they  are  then  wrung 
out  drv  in  a  wrincrincr-machine  such  as  is  used  in  a  laun- 
dry.  The  rubber  rollers  of  the  wringing-machine  will 
dry  a  sponge  almost  completely,  and  the  compression 
squeezes  out  all  the  dirt  that  may  remain  and  also  all  the 
bi-chloride  :  this  could  not  be  done  as  thoroughly  with  the 
hands,  nor  does  one  wish  to  keep  putting  his  hands  into 
a  mercurial  solution.  iVfter  these  sponges  have  been 
soaked  in  this  mercuric  solution,  they  are  cast  into  a  jar 
containing  a  solution  of  carbolic-acid  1.20,  and  \N'hen 
wanted  are  taken  out  of  the  jar  and  wrung  out  again  in 
the  wringer  and  taken  in  a  clean  bag  to  the  operation. 
I  have  always  used  carbolic  acid  spray  and  continue  to 
do  so  ;  though  I  think  it  unnecessary,  yet  I  hate  to  give 
it  up.      I  use  an  electric  light  when  necessary. 

Of  m}'  first  five  unantiseplic  ovariotomies  all  died. 
Of  my  antiseptic  ovariotomies  248  have  recovered  and 
34  have  died.  About  one  quarter,  probably,  of  all  the 
fatal  cases  are  to  be  attributed  to  some  error  or  careless- 
ness of  mine,  to  some  want  of  cleanliness,  or  perhaps  to 
a  slightly  suppurating  hang-nail  or  other  sore  on  my 
hands,  or  to  something  that  might  have  been  avoided. 


5 

Perhaps  this  comes  from  too  much  operating  within  a 
given  time.  Deaths  for  which  I  am  inclined  to  think  I 
am  at  fault,  have  occurred  generally  towards  the  end  of 
many  daily  ovariotomies,  when  I  may  have  been  tired  or 
possibly  unclean.  To  balance  these  fatal  cases  of  course 
many  unexpected  recoveries  have  occurred.  There  is 
also  an  element  which  cannot  be  estimated  beforehand, 
viz:  the  viability  of  the  patient  (if  I  may  say  so),-  just 
as  it  will  take  many  blows  to  kill  one  man,  any  one  of 
which  would  have  killed  another  less  viable  man  ;  so,  a 
moderately  severe  operation  will  be  fatal  in  a  certain 
case,  and  a  much  more  severe  one  will  be  innocuous  in 
another  case.  I  mean  where  both  patients  seem  to  be 
equally  healthy.  This  vitality  or  viability  it  is  impossible 
to  estimate  beforehand.  There  are  other  causes  of  death 
which  are  unpreventable.  Such  a  one  is  the  case  of  death 
from  Acute  Mania,  No.  6^  ;  another  one  the  death  from 
Tetanus  ;  another  the  death,  sixteen  days  after  the  opera- 
tion, when  recovery  seemed  complete,  from  thrombus  in 
all  the  pulmonary  arteries,  No.  275.  Let  me  illustrate 
this  point.  No.  117,  a  simple,  uncomplicated  case,  died, 
while  cases  No.  72,  where  the  bladder  was  cut  open,  and 
No.  260,  in  which  a  second  operation,  including  removal 
of  the  uterus,  was  done,  and  No.  50,  complicated  with 
heart  disease,  curvature  of  the  spine  and  the  removal  of 
not  only  ovarian  but  uterine  tumors,  have  recovered. 
The  causes  of  death  have  usually  been  Peritonitis  and 
Septicaemia.  You  may  call  it  Septic-Peritonitis  or 
Septicaemia,  or  blood-poisoning,  but  it  is  fatal,  and  I  am 
rather  skeptical  about  deaths  from  intestinal  obstruction 
of  a  mechanical  nature  at'ter  Laparotomy,  except  as  the 
intestines  are  paralyzed  by  Peritonitis.  There  is  often 
a  sort  of  atony  of  the  bowels  which  is  almost  equivalent 
to  mechanical  obstruction,  and  which  gives  rise  to  great 
distention  and  to  vomiting,  but  there  is  no  real  strangu- 


lation  such  as  you  see  in  Hernia,  or  at  least  I  have  never 
seen  such  a  case. 

Two  cases  in  which  I  wounded  the  bladder  during 
ovariotomy  recovered,  and  they  are  both  living  in  good 
health,  two  and  six  years  respectively  after  the  opera- 
tion. In  both  cases  the  bladder  was  sewn  up  with  silk 
and  in  both  cases  the  sutures  were  left  shut  up  within 
the  abdominal  cavity.  Of  those  \vho  recovered,  nine 
have  since  died  of  abdominal  cancer  a  few  months  or 
years  after  recovery,  and  thirty  have  ventral  hernia.  I 
have  heard  of  fifteen  children  born  to  eleven  women 
out  of  about  two  hundred  heard  from.  The  sexes  do 
not  correspond  to  the  ovaries.  The  patients'  ages  have 
varied  from  twelve  to  seventy-three  years.  In  size,  the 
weight  of  the  sac  and  its  contents  has  varied  from  a 
pound  to  one  hundred  and  eleven  and  a  half  pounds. 
Twisted  pedicle  occurred,  I  think,  six  times. 

The  usual  length  of  my  incision  is  about  two  inches, 
except  in  fat  people,  or  where  some  difficulty  in  the 
operation  requires  more  room.  I  never  leave  a  clamp 
on  the  ovarian  pedicle,  but  always  tie  and  burn  the  stump 
and  drop  it  back.  I  have  always  used  silk  sutures  and 
am  careful  to  include  all  the  abdominal  parietes  in  the 
suture,  particularly  the  transversalis  fascia. 

Drainage  was  used  in  fifteen  cases  of  ovariotomy  I 
think,  and  I  have  gradually  reduced  the  size  of  my 
drainage  tubes.  In  three  cases  silk  sutures  have  been 
discharged  at  long  intervals  after  recover}^,  respectivel}^ 
I  have  had  one  case  of  Tetanus  following  a  simple  un- 
complicated ovariotomy.  Death  occurred  on  the  sixth 
day,  the  symptoms  existing  for  twenty-four  hours  before 
deatli. 

I  have  had  one  case  of  the  formation  of  a  stone  in  the 
bladder,  around  the  dermoid  contents  of  the  tumor  dis- 
charged into  the  bladder. 


Most  of  my  cases  have  been  treated  in  a  private  hos- 
pital, which  is  simply  an  ordinar}-  dwelling  house. 
During  convalescence,  the  patients  have  found  the  lift- 
ing-machine, figured  in  Hamilton's  Surgerv  as  Dr. 
Jenks"  Fracture  Bed,  very  useful,  portable,  light  and 
strong.  I  have  found  none  of  the  Fracture-beds  such 
as  those  of  Crosby  and  others  of  any  special  service.  I 
use  a  catheter  as  little  as  possible,  preferring  to  have  the 
patients  pass  their  water  voluntarih'  from  the  very  first, 
if  possible. 

My  greatest  number  of  consecutive  recoveries  after 
ovariotomy  has  been  thirty-eight,  I  think. 

Suppurating  cysts  of  the  ovary  are  spoken  of  and 
described  not  unfrequently.  I  never  saw  but  one  and 
that  had  been  tapped.  I  doubt  if  an  ovarian  cyst  ever 
suppurates  unless  there  has  been  at  some  time  a  com- 
munication with  the  external  air,  or  with  some  mucous 
cavity.  But  there  is  a  fluid  containing  fat  and  sebaceous 
matter,  that  to  the  naked  e3-e  looks  exacth'  like  laudable 
pus,  and  can  only  be  distinguished  from  it  by  microscop- 
ical examination. 

The  removal  of  sessile  tumors  is  accomplished  by  a 
sort  of  knack  learned  by  experience,  at  least  it  has  been 
by  me.  You  find  the  cyst  covered  with  peritoneum  and 
immovable,  but  if  you  cut  through  the  outer  adherent 
covering  of  peritoneum  at  se^•eral  points,  you  will  usually 
strike  the  familiar-looking  w^all  of  the  ovarian  cj'st  some- 
where, and  may  succeed  in  enucleating  it  and  making  a 
sort  of  pedicle. 

I  recall  two  cases  of  swelling  of  the  parotid  gland 
after  ovariotomy.  Both  recovered  quickly,  and  I  have 
not  regarded  an  enlargement  of  the  parotid  during  con- 
valescence as  of  special  importance.  I  may  add  that 
cases  of  parotitis  seen  in  consultation  have  recovered, 
and  I  have  generally  given  a  favorable  prognosis. 


8 


In  regard  to  hysterectomy,  my  success  has  not  been 
great.  ]Mv  cases  of  removal  of  uterine  fibroid  tumors 
number  twenty-seven,  with  seventeen  recoveries  and  ten 
deaths.  I  perform  the  operation  much  better  than  I  did 
years  ago,  and  my  later  cases  have  nearly  all  recovered, 
but  still  I  am  not  fond  of  it  and  always  rather  shrink  from 
it.  I  never  do  it  unless  the  patient  seems  in  danger  of 
her  life  from  heemorrhage.  mechanical  pressure,  or  ex- 
haustion, or  else  suffers  such  pain  that  life  is  not  worth 
living.  I  do  not  know  which  is  the  better  way  of  man- 
aging the  stump,  whether  intra  or  extra-peritoneally  :  I 
am  pretty  sure,  however,  that  with  me  the  extra-peritoneal 
is  safer,  although  I  cannot  say  that  a  more  skillful  opera- 
tor might  not  make  the  intra-peritoneal  method  safe  and 
reliable. 

Encouraged  by  the  recovery  of  a  patient  after  hyster- 
ectomy for  fibro-myoma  in  which  the  stump  had  been 
left  in  the  abdomen,  I  treated  the  next  case  intra-perito- 
neally,  with  fatal  result.  The  autopsy  showed  that  the 
stump  was  the  cause  of  a  quite  limited  peritonitis,  and 
that  if  it  had  been  left  outside  the  patient  would  appar- 
ently have  been  relieved  of  the  source  of  blood-poison- 
ing, and  might  have  recovered.  I  use  a  wire  ecraseur, 
either  Koeberle's  or  a  longer  one,  for  I  find  that  for  the 
compression  of  the  pedicle  Koeberle's  screw  is  not  long 
enough,  and  one  must  have  se\eral  of  Koeberle's  serre- 
nceuds  or  else  an  instrument  with  a  longer  screw,  and 
the  latter  seems  to  me  simpler.  I  have  used  drainage 
several  times  after  removal  of  fibroid  tumors,  but  it  is 
usuall}-  unnecessary.  When  the  clamp  and  pin  come 
away,  there  is  usually  some  fluid  in  the  cavity  where  the 
stump  was,  and  this  has  often  a  very  offensive  odor  like 
that  of  a  sewer,  but  it  seems  of  no  consequence,  as  the 
patient's  temperature  and  pulse  are  nearly  normal.  I 
suppose  there  is  a  septic-putrescence  and  a  non-septic- 
putrescence  ;  but  at  the  first  glance  one  would  suppose 


that  an  ounce  or  so  of  black,  offensive  fluid  between  the 
intestines  and  the  bladder,  and  within  the  peritoneal  cav- 
ity, would  necessarily  set  up  Septicemia  or  Peritonitis. 

The  smell  that  I  mean  is  very  much  like  that  from 
macerating  bones,  and  yet  there  is  no  Septiceemia  and 
the  patient  recovers,  the  hole  closing  rapidly.  I  am  sat- 
isfied, on  the  whole,  with  the  extra-peritoneal  treatment 
of  the  pedicle  by  means  of  a  screw  serre-nceud,  though 
the  intra-peritoneal  method  is  neater.  The  wire  seeks 
a  bed  for  itself  in  the  part  of  the  tumor  where  the  diam- 
eter is  smallest,  and  it  is  almost  impossible  to  keep  it 
from  gravitating  to  this  point.  It  must  be  kept  off  the 
bladder,  of  course.  I  had  a  recovery,  however,  in  one 
case  where  two  successive  wires  broke  on  being  tight- 
ened, and  in  which  I  found,  twenty-four  hours  afterward, 
that  a  piece  of  the  bladder  was  in  the  serre-noeud.  The 
opening  in  the  bladder  subsequently  closed  without 
suture  by  keeping  a  catheter  in  the  urethra  ;  so  I  know 
that  when  one  is  unfortunate  enough  to  have  taken  a 
piece  out  of  the  apex  of  the  bladder,  at  least  an  inch  in 
diameter,  he  may  expect  recovery  if  he  will  keep  a 
Sims'  catheter  in  the  bladder  and  urethra  all  the  time. 
Mv  patient's  fistula  closed  in  six  weeks. 

Of  cases  of  ovarian  tumor,  uncomplicated  except  by 
adhesion  in  which  I  could  not  or  thought  I  could  not  (for 
I  can  get  a  cyst  out  now  that  I  could  not  have  removed 
five  or  six  years  ago)  remove  the  cysts,  and  which  I 
have  stitched  to  the  abdominal  walls  or  fastened  outside, 
I  have  had  nine.  Of  these  all  have  completely  recov- 
ered. In  these  cases,  the  cysts  had  grown  under  the 
peritoneum,  and  were  adherent  to  the  intestines,  to  the 
broad  lio-ament  or  uterus,  and  in  one  instance  the  wall 
of  the  cyst  and  its  peritoneal  adhesions  in  the  right  iliac 
region  were  over  two  inches  thick  and  very  dense,  and 
yet  the  patient  recovered,  and  is  perfectly  well  and  hearty 
to-day.     If  in  these  cases  you  can  strike  the  cyst  wall 

2 


lO 


without  too  much  hgemorrhage  or  violence,  you  can  gen- 
erally remove  the  cyst.  Of  cases  where  I  have  opened 
the  abdomen  and  tapped  or  more  or  less  emptied  the 
cyst,  I  have  had  several,  nearly  all  of  which  died. 
These  partial  operations  are  generally  bad  surgery,  and 
a  man  does  them  less  and  less  the  more  he  operates.  Of 
cases  of  collections  of  pus  in  the  abdominal  cavit}^  I  have 
had  but  one,  and  that  was  treated  successfully  by  Lapar- 
otomy and  drainage.  Of  cases  of  abscess  in  the  ovary 
and  salpingitis  of  gonorrhoeal  origin,  I  have  had  one 
case,  successfully  treated  by  removal  of  both  tubes  and 
one  ovary,  the  other  ovary  being  so  imbedded  in  the 
pelvic  tissues  as  to  be  immovable.  The  patient  recov- 
ered. Of  removal  of  large  intra-abdominal  fatt}^  tumors, 
sub-peritoneal,  I  have  had  two.  They  each  weighed 
over  fifty  pounds  and  were  many-lobed.  One  occurred 
in  a  man  and  the  other  in  a  woman,  and  both  were  fatal. 
In  connection  with  the  subject  of  intestinal  obstruction 
it  may  not  be  improper  for  me  to  say  that  I  have  had  one 
case  of  an  operation  for  the  closure  of  a  Meckel's  Divert- 
iculum (Omphalo-Mesenteric  Remains).  In  this  case, 
the  mucous  membrane  projecting  at  the  umbilicus  was 
pulled  up  and  cut  off,  and  the  skin  within  the  umbilical 
cicatrix,  over  a  diameter  of  about  a  quarter  of  an  inch, 
was  removed,  and  the  denuded  surfaces  united  by  silver 
sutures.  The  patient  was  an  infant  about  five  months 
old.  The  cure  was  complete.  Another  case,  interesting 
in  connection  with  this,  was  a  case  of  Laparotomy  with 
intestinal  obstruction,  caused  by  Meckel's  Diverticulum 
in  a  young  man  of  twenty-one  years.  I  failed  to  find 
the  obstructing  band,  owing  to  m}^  ignorance  at  the  time 
of  the  causation  of  intestinal  obstruction  by  the  Diverti- 
culum, and  the  case  resulted  fatally.  It  is  described  at 
length  by  Prof.  Fitz  in  the  American  Journal  of  Med- 
ical Science  for  July,  1884.  Once  during  ovariotomy  I 
removed    a    portion    of  a  cancerous  omentum,   and  the 


II 


patient  has  experienced  up  to  the  present  time,  one  and 
a  half  years  from  the  date  of  the  operation,  no  trouble, 
and  has  been  in  perfect  health. 

I  have  had  one  very  remarkable  case  of  cure  of  tuber- 
cular peritonitis  and  dropsy  by  Laparotomy,  the  patient 
being  now  fat  and  healthy,  three  years  after  the  opera- 
tion. Fluid  was  discharged  from  the  wound  for  about 
eight  months,  and  there  is  now  a  discharge  of  about  a 
half  a  drachm  a  day  from  a  short  sinus. 

Of  removals  of  the  Kidney  for  Sarcoma,  Cancer  or 
Abscess,  depending  on  calculous  nephritis,  I  have  had 
three  cases,  all  of  which  were  fatal.  The  operations 
seemingly  went  off  very  well,  but  no  urine  excepting  a 
few  ounces  was  secreted  up  to  the  time  of  death,  about 
two  da3's  in  each  case.  Almost  complete  suppression 
had  taken  place  in  these  cases. 

Of  the  formation  of  an  ardficial  anus,  for  Cancer, 
either  by  Lumbar  Colotomy  or  anterially  in  the  pubic 
region,  I  have  had  five  cases,  three  of  which  were  suc- 
cessful, the  life  of  the  patients  being  rendered  comfort- 
able for  man}'  months. 

I  have  had  many  cases  of  operation  for  Strangulated 
Hernia,  which  I  suppose  ought  hardly  to  be  mentioned 
in  a  paper  on  Laparotomy. 

I  have  successfully  removed  a  fibroid  tumor  in  the 
abdominal  fascia  and  peritoneum  of  the  right  lumbar 
region,  the  size  of  a  small  placenta,  by  Laparotomy. 
The  patient  is  now  in  good  health  four  years  after  opera- 
tion. As  some  of  the  peritoneum  was  removed,  and  its 
edges  could  not  be  brought  together,  there  has  been  a 
troublesome  rupture.  This  is  the  only  case  of  fibroma 
of  the  peritoneum  I  have  ever  seen. 


CHAPTER   II. 


OVARIOTOMIES 


Illusti'ative  Cases. 


Case  No.  IX.  Remarkable  as  having  no  pedicle. 
It  was  a  cyst  of  the  broad  ligament,  and  as  the  woman 
coughed,  after  the  peritoneum  was  opened  and  the  cyst 
tapped,  the  cyst  was  expelled  and  dropped  on  the  floor 
without  a  vessel  being  tied  or  an}-  force,  except  the 
gentlest  assistance,  being  used.  The  operation  from 
the  first  incision,  till  all  the  sutures  had  been  tied,  was 
ten  minutes.  Tlie  C3'st  measured  36  inches  in  circum- 
ference. 

Case  No.  X.  Acute  peritonitis  at  time  of  operation, 
September  29,  1878.  Confined  Nov.  16,  1879,  after  a 
normal  labor.  Child,  a  girl.  Ovar\'  remaining,  the 
right. 

Cases  Nos.  XII  and  XIII.  Both  died  subsequently 
to  recovery  of  abdominal  cancer,  and  one  also  with 
thoracic  cancer.  Their  deaths  occurred,  one  in  six 
months,  and  one  in  five  months  after  recovery. 

Case  No.  XIX.  Is  only  of  interest  as  having  men- 
struated for  two  years  irregularly,  after  the  removal  of 
both  ovaries. 

Case  No.  XXIX.  Cyst  of  left  broad  ligament,  died 
of  cancer  of  stomach  within  a  year. 


13 

Case  No.  XXXI.  Was  confined  in  October,  1881, 
fourteen  months  after  Ovariotomy.  Child,  a  girl.  Ovary- 
remaining,  the  right. 

Case  No.  XXXIII.  Is  remarkable  as  having  had  40 
ounces  of  serum  removed  by  aspiration  from  the  left 
thoracic  cavity,  on  account  of  acute  pleurisy,  on  the 
fourth  day  after  Ovariotomy. 

Case  No.  XXXV.  Died  of  abdominal  cancer  nine 
months  after  recovery. 

Case  No.  L.  Is  remarkable  on  account  of  her  recov- 
ery. She  had  severe  cardiac  disease,  great  deformity 
from  curvature  of  the  spine,  and  at  the  operation  three 
tumors  were  removed,  a  solid  tumor  of  the  right  ovary, 
a  dermoid  tumor  of  the  same,  and  a  fibroid  tumor  of  the 
uterus.     She  died  three  years  later  of  heart  disease. 

Case  No.  LVI.  Is  remarkable  as  requiring  colotomy, 
or  rectotomy,  for  cancer  of  the  bowel,  Dec.  21,  1881, 
seven  months  after  recovery.  The  artificial  anus  was 
made  in  the  pubic  region.  Her  life  was  very  comfort- 
able for  many  months.  She  died  of  abdominal  cancer, 
in  November,  1882. 

Case  No.  LXI.  Died  several  months  after  recovery, 
from  cancer  of  the  stomach. 

Case  No.  LXVII.  Is  exceptional  as  having  died  of 
Acute  Mania,  on  the  eighth  day  after  Ovariotomy.  A 
careful  autopsy  found  everything  going  on  well  in  the 
peritoneal  cavity,  and  no  recognizable  cause  for  death. 
I  think  the  case  might  be  disregarded  as  one  of  fatal 
Ovariotomy,  but  I  have  thought  it  right  to  put  it  in  the 
table  as  such. 


14 

Case  No.  LXXII.  Is  an  instance  of  a  most  fortunate 
uninterrupted  recovery  after  an  incision  of  the  bladder. 
The  convalescence  was  extraordinarily  devoid  of  fever, 
the  temperature  never  rising  above  99°.  A  Sims' 
catheter  was  kept  in  the  urethra  for  nine  days.  The 
bladder  wound  was  sewed  up  with  a  continuous  suture 
of  carbolized  silk,  and  was  closed  tight  at  the  time  of 
the  operation.  The  patient  is  now,  six  years  after  the 
operation,  in  perfect  health,  and  has  never  had  a  symp- 
tom of  vesical  or  other  trouble. 

Case  No.  LXXVI.  Is  remarkable  on  account  of  the 
age  of  the  patient  at  the  time  of  the  operation,  and  her 
uninterrupted  good  health  since.  She  is  now  hale  and 
hearty  at  the  age  of  79. 

Case  No.  LXXVII.  In  this  case  a  recurrence  of 
the  disease,  gelatinous  cancer,  took  place,  and  more  or 
less  fluid  was  discharged  after  recovery,  through  the 
abdominal  cicatrix,  and  through  the  bladder.  The  tu- 
mor was  a  burst  gelatinous  dermoid  cyst,  and  weighed 
35  pounds.  This  material  was  scooped  out  and  sponged 
out  as  thoroughly  as  possible.  The  patient  was  much 
relieved  by  the  operation,  and  gained  flesh  and  strength. 
Two  years  after  her  recovery,  I  removed  a  calculus  from 
the  bladder,  the  nucleus  being  a  hair  which  had  prob- 
ably remained  in  the  peritoneal  cavity,  after  the  opera- 
tion, and  had  found  its  way  into  the  bladder.  She  died 
in  1885,  four  years  after  Ovariotomy,  of  general  abdom- 
inal cancer. 

Case  No.  LXXX.  Is  a  case  of  the  most  rapid  recur- 
rence of  cancer  after  Ovariotomy,  that  has  occurred 
among  my  cases.  There  were  masses  of  cancerous- 
looking  nodules  in  the  abdominal  parietes,  which  were 
cut  throuirh   in   making   the   incision.     The   tumor  was 


T5 

sarcomatous-looking,  and  more  solid  than  cystic.  It 
weighed  26  pounds.  The  operation  having  been  done 
on  March  14,  1S82,  the  patient  died  on  May  19,  with 
large,  rapidly-growing  soft,  sarcomatous  tumors  in  the 
abdomen.  Another  remarkable  occurrence  in  the  case, 
and  one  that  will  hardly  be  credited,  was  the  occurrence 
of  two  well-formed  vaccination  vesicles,  which  appeared 
spontaneously  on  the  cicatrices  of  two  successful  vacci- 
nations done  eight  years  before.  These  vesicles  ran  a 
normal  course.  The  late  Dr.  Henry  A.  Martin  was 
kind  enough  to  confirm  my  diagnosis,  and  told  me  that 
the  occurrence  of  similar  spontaneous  vaccine  disease 
had  once  or  twice  been  recorded.  There  was  no  possi- 
bility of  contagion.  The  patient  was  ill,  confined  to  her 
bed,  and  had  no  visitors,  and  no  one  in  the  house  had 
been  vaccinated  recently.  I  think  the  element  of  con- 
tagious inoculation  is  entirely  excluded,  and  the  case 
may  be  received  as  one  of  spontaneous  vaccine  disease, 
appearing  in  an  old  cicatrix,  and  caused  in  some  unex- 
plained way  by  the  patient's  condition.  It  is  perhaps 
unnecessary  for  me  to  say  that  the  observation  is  unique 
in  my  experience,  and  it  will  be  interesting  to  know  if 
others  have  observed  any  similar  phenomenon  after 
Ovariotomy. 

Case  No.  LXXXI.  Recovered  rapidly  in  1882,  and 
after  enjoying  four  years  of  health,  noticed  that  she  was 
growing  larger.  She  put  herself  under  my  care  in 
1887,  and  I  made  an  exploratory  incision  to  remove  an 
adherent  tumor  of  the  other  (the  left)  ovary,  but  I  could 
do  nothing,  and  she  died  in  a  few  days  of  peritonitis. 

Case  No.  LXXXII.  Was  one  of  the  largest  tumors 
I  have  removed,  the  solid  and  fluid  contents  removed 
a  few  days  before,  and  at  the  operation,  weighing  105 
pounds.  The  patient  is  now,  five  years  later,  in  robust 
health. 


i6 


Case  No.  LXXXIV.  Although  the  posterior  surface 
and  right  side  ot^  uterus  was  "  peeled  "  and  denuded  of  its 
peritoneal  covering,  and  tied  and  sewn,  and  burnt  to 
control  hgemorrhage,  pregnancy  has  taken  place  twice, 
once  in  1883,  and  once  in  1885.  The  first  child  was  a 
female,  and  the  second  a  male.  The  ovary  remaining 
was  the  right. 

Case  No.  LXXXIX.  This  lady  had  a  very  rapid 
recovery  following  Ovariotomy,  in  1882,  the  temperature 
only  once  rising  above  the  normal.  In  1884  she  sent 
for  me  and  I  found  her  very  feeble,  emaciated,  with  a 
large,  hard  nodulated  tumor  filling  the  pelvis  and  lower 
abdominal  region,  and  projecting  into  and  through  the 
cicatrix  of  the  abdominal  incision  ;  the  inguinal  glands 
were  also  affected,  and  there  had  been  haemorrhage 
from  the  surface  of  the  tumor.  Vomiting  was  almost 
constant.  Nothing  could  be  done  in  the  w^ay  of  an 
operation,  and  she  died  in  June. 

Case  No.  CII.  Was  one  of  suppurating  cyst  in  a 
woman  37  3^ears  old.  She  had  been  tapped  three  weeks 
before  the  operation.  Her  temperature  was  high,  loi'' 
before  operation,  and  rapidly  fell  to  normal.  Her  re- 
covery w^as  rapid. 

Case  No.  CIV.  Was  one  accompanied  by  heemor- 
rhage  during  the  operation  from  two  arteries  near  the 
aorta  in  the  left  lumbar  region.  Her  convalescence  was 
accompanied  by  a  high  temperature,  rising  to  104"  on 
the  7th  day,  and  by  a  severe  and  constant  diarrhoea 
and  more  or  less  dysentery  ;  but  she  left  for  home  on 
the  25th  day,  and  has  since  been  remarkably  well. 

Case  No.  CVII.  One  of  dermoid  tumor,  followed 
by  death  from  cancer,  three  months  after  the  operation. 


17 

Case  No.  CXVIII.  Was  one  of  normal  recovery 
after  Ovariotomy  in  a  woman  68  years  old.  This  was 
followed  by  a  return  of  the  disease  in  the  other  ovary 
and  a  large  ventral  hernia.  In  1887  a  tumor  of  the  left 
ovary,  together  with  the  adherent  uterus,  was  removed; 
the  hernia  was  cured  and  the  patient,  now  seventy-three 
years  old,  went  home  well. 

Case  No.  CXXXVIII.  Was  confined  in  August, 
1886,  three  years  after  Ovariotomy ;  child,  a  female ; 
labor  easy  and  rapid ;  left  ovary  remaining. 

Case  No.  CXLII.  Recovered  after  removal  of  a 
large  tumor  of  the  right  ovary  in  1883.  She  has  been 
confined  twice  since  ;  once  in  1884,  and  once  in  1885  ; 
both  children  were  females.     The  left  ovary  remained. 

Case  No.  CXLIV.  Is  remarkable  for  two  circum- 
stances. The  discharge  of  a  ligature  of  silk  from  the 
wound  two  years  after  recovery,  and  a  desire  for  sexual 
intercourse  since  Ovariotomy,  whereas,  before  the  re- 
moval of  the  ovary  she  had  no  desire,  and  in  fact  dis- 
gust. The  silk  is  coarse  and  strong  and  is  absolutely 
unchanged,  the  knot  being  as  perfect  as  when  tied,  and 
the  ends  and  edges  as  sharply  defined  as  when  cut  ofii" 
by  the  scissors  two  years  before. 

Case  No.  CLXIV.  Is  one  of  the  cases  that  died 
subsequentl}^  of  abdominal  cancer,  two  years  after  op- 
eration. 

Case  No.  CLXVII.  Is  not  properly  a  death  after 
Ovariotomy,  as  cancer  of  the  omentum,  bowels,  ovary, 
and  bladder  was  present,  and  a  cancerous  mass  was 
removed  from  the  bladder  and  the  bladder  opened;  but 
the  ovary  was  removed,  and  so  I  have  called  it  a  death 
from  Ovariotomy. 

3 


i8 


Case  No.  CLXXII.  One  of  multilocular  cyst  of  the 
left  ovary.  Was  confined  June  5,  1886,  nineteen  months 
after  Ovariotomy.  Child,  a  male.  The  right  ovary  re- 
maining. 

Case  No.  CXCIV.  Was  a  very  severe  one.  The 
cvst  had  grown  into  the  broad  ligament  and  liad  no 
pedicle.  It  was  forcibly  and  violently  enucleated,  and 
there  was  much  hemorrhage.  The  pedicle,  such  as  it 
was,  was  a  part  of  the  uterus,  and  many  ligatures  were 
applied.  A  drainage  tube  was  used.  I  expected  a  fatal 
result,  but  the  patient  reacted  well  and  has  since  enjoyed 
good  health,  with  the  exception  that  a  sinus  has  remained 
in  the  course  of  the  wound.  In  June,  1885,  fourteen 
months  after  the  operation,  the  first  suture  of  silk  was 
discharged  ;  and  subsequently  five  more  ligatures  have 
been  discharged,  the  knots  being  firm,  and  the  silk 
sound.  These  ligatures  were  discharged  in  January, 
May,  October,  and  December,  1S86,  and  in  January, 
1887. 

Case  No.  CXCV.  Was  a  successful  hysterectomy, 
as  well  as  an  Ovariotomy. 

Case  No.  CXCVI.  Was  m}^  first  fibroid  tumor  of  the 
ovary,  and  had  been  considered  a  fibroid  tumor  of  the 
uterus,  by  myself  and  other  ovariotomists  elsewhere. 

Case  No.  CXCVIII.  Was  one  of  rapid  development 
of  abdominal  cancer,  with  ascites,  and  death  tour  months 
after  recovery. 

Case  No.  CCVIII.  Was  the  second  case  of  fibroid 
tumor  of  the  ovary,  and  with  it  were  connected  cysts, 
but  the  primary  tumor  which  filled  the  pelvis  was  fibroid 
in  its  structure.  This  case  and  No.  CXCVI  are  the 
only  libroid  tumors  of  the  ovary  I  ever  saw. 


19 

Case  No.  CCX.  Is  remarkable  in  many  ways.  She 
had  been  tapped  eighteen  times.  The  fluid  from  the 
more  recent  tappings  had  been  ascitic,  she  was  emaci- 
ated and  leeble,  and  her  abdomen  contained  much  fluid, 
and  at  least  two  hard  tumors  that  felt  like  flbroids,  and 
were  very  close  to,  if  not  a  part  of,  the  uterus.  On  open- 
ing the  abdomen  in  the  usual  place,  the  abdominal  walls 
seemed  more  thick  and  vascular  than  usual,  and  yet  be- 
neath them  could  be  felt  the  ascidc  fluid.  On  cutdng 
deeper,  a  tissue,  looking  like  the  lining  membrane  of  the 
bladder,  was  seen.  The  incision  at  this  point  was  aban- 
doned, and  a  new  one  made  at  the  umbilicus  ;  here  the 
normal  peritoneum  was  easily  opened.  About  twenty 
pounds  of  ascitic  fluid  ran  out,  and  when  the  abdominal 
cavity  was  empty  of  fluid  two  papillomatous  tumors  of 
the  ovaries  were  seen.  The  right  was  the  larger;  both 
had  been  burst  for  some  time,  and  papillomatous  mate- 
rial extended  beyond  the  cyst  wall  of  each.  After  the 
pedicles  had  been  tied  close  to  the  uterus,  the  bladder 
was  inspected.  It  was  found  that  the  wall  of  the  bladder 
was  a  part  of  the  anterior  abdominal  parietes,  and  that 
it  had  been  opened  for  an  extent  of  about  four  inches. 
The  outer  walls  of  the  bladder  were  sewn  together, 
about  twelve  interrupted  sutures  of  silk  being  put  in. 
Care  was  used  so  as  not  to  include  the  mucous  mem- 
brane. A  drainage  tube  was  used  in  the  abdominal 
cavity,  and  a  catheter  was  kept  in  the  bladder.  On  the 
whole,  the  operation  was  completed  in  a  satisfactor}'  and 
workmanlike  manner.  This  incorporation  of  the  blad- 
der with  the  abdominal  parietes  and  its  extent  upwards 
towards  the  umbilicus  is  an  anatomical  anomaly  ot  great 
awkwardness  to  the  ovariotomist.  The  convalescence 
was  tedious,  and  accompanied  by  much  pain  and  some 
considerable  suppuration,  but  the  patient  went  home 
after  six  weeks,  and  now  writes  that  her  health  (two 
years  after  the  operation)  is  perfect,  but  that  the  cicatrix 
has  never  entirely  closed. 


20 


Case  No.  CCXII.  Is  remarkable  as  being  the  only 
cyst  of  the  broad  ligament  that  contained  papillomatous 
masses,  the  ovary  not  being  affected.  The  wall  of 
the  cyst  was  quite  thick,  perhaps  half  an  inch  thick, 
whereas  the  walls  of  most  cysts  of  the  broad  ligament 
are  thin  and  rather  delicate. 

Case  No.  CCXIII.  Was  one  of  twisted  pedicle. 
The  patient  was  62  years  old.  On  opening  the  abdo- 
men, the  cyst  was  seen  adherent  and  blackish  on  the 
surface.  The  pedicle  fon  the  left  side)  was  found  to  be 
tightly  twisted  four  times,  and  was  rigid  and  white. 
The  vessels  were  all  plugged  and  no  ligature  was 
required. 

Cases  Nos.  CCXV  and  CCXVI.  Were  both  simple 
cases  in  healthy  3^oung  women,  both  were  fatal,  and  were, 
it  will  be  seen,  consecutive  ;  the  same  cause  of  Septicism 
was  present  in  both  cases.  They  occurred  during  al- 
most daily  operating,  and  their  fatal  results  are  to  be 
attributed  to  some  fault  of  mine,  but  exactly  what  I  don't 
know. 

Case  No.  CCXVIII.  Was  confined  November  i, 
1886,  thirteen  months  after  her  recovery  from  Ovariotomy. 
The  child  was  a  female,  the  left  ovar}^  remaining. 

Case  No.  CCXXII.  Was  one  of  rapid  recovery  in  a 
lady  61  years  old.  It  is  remarkable  as  being  the  only 
one  I  have  seen  and  tried  to  relieve  of  intestinal  obstruc- 
tion caused  by  the  operation.  I  was  called  in  April, 
1886  (four  months  after  her  recovery),  on  account  of 
symptoms  of  obstruction  which  had  existed  for  several 
days.  On  opening  the  abdomen  I  found  the  small  in- 
testine adherent  at  intervals  to  the  cicatrix  in  the  perito- 
neum ;  through  the  openings  between  the  intestine  and 


21 


the  abdominal  wall  several  loops  of  intestine  had  passed, 
then  had  become  strangulated  and  sphacelated,  and 
there  was  more  or  less  offensive  blackish  fluid  in  the  ab- 
dominal cavity.  An  artificial  anus  was  made  and  gave 
relief,  but  the  patient  died  in  a  few  days. 

Case  No.  CCXXVIII.  Recovered,  and  went  home 
towards  the  last  of  February,  1886.  She  was  delivered 
of  a  child,  a  female,  December  13,  1886,  less  than  ten 
months  after  leaving  for  home,  and  just  ten  and  a  half 
months  after  Ovariotomy  on  January  27,  1886.  The 
ovarv  remaining  was  the  left.  This  is  very  quick  work, 
Ovariotomy,  recover}^  impregnation  and  delivery,  all 
within  eleven  months. 

Case  No.  CCXXIX.  Should  not  be  counted  among 
the  Ovariotomies.  The  patient  was  in  articulo  mortis, 
and  the  cyst,  a  gangrenous  one  with  a  twisted  pedicle, 
was  only  removed  because  I  knew  that  I  should  feel  at 
the  autopsy  as  if  I  ought  to  have  removed  the  cyst  while 
the  patient  was  alive,  even  if  recovery  seemed  im- 
possible. 

Case  No.  CCXXXVIII.  Was  another  case  of  twisted 
pedicle. 

Case  No.  CCXL.  Was  a  double  Ovariotomy,  with 
ascites  and  myxomatous  tumors.  A  piece  of  omentum, 
thick  and  apparently  cancerous,  about  an  inch  and  a 
half  in  diameter,  was  removed  also.  Ovariotomy  was 
done  in  April,  1886,  and  now,  July,  1887,  she  is  in  ex- 
cellent health.  On  deep  pressure,  a  small  movable 
tumor  can  be  felt  in  the  right  umbilical  or  iliac  region, 
but  the  omental  tumor  has  apparently  not  increased  in 
size. 


22 


Case  No.  CCLI.  A  simple  enough  operation,  ex- 
cept that  a  hard  (dermoid?)  tumor,  about  the  size  of  an 
English  walnut  and  without  a  pedicle,  was  removed 
Irom  the  peritoneal  region  above  the  bladder ;  perhaps 
this  was  the  left  ovary  which  had  become  detached  at 
some  former  time.  The  tumor  was  a  multilocular  one 
of  the  right  ovary  with  adhesions,  and  the  patient  did 
perfectly  well  till  the  fifth  day,  when  she  began  to  have 
stiffness  of  the  jaws  and  spasms  of  a  convulsive  nature. 
She  died  on  the  sixth  day  of  Tetanus. 

Case  No.  CCLII.  Is  the  largest  I  have  ever  re- 
moved; the  tumor  and  contents  weighing  iiij  pounds. 
The  patient  recovered. 

Case  No.  CCLXI.  Is  remarkable  as  being  a  second 
Ovariotomy  on  a  patient  72  years  old,  and  with  a  large 
ventral  hernia,  and  in  whom  the  uterus  had  to  be  re- 
moved with  the  tumor.  The  case  was  successful  and 
the  hernia  w^as  cured.     Drainage  was  used. 

Case  No.  CCLXII.  Was  another  case  where  the 
uterus  was  removed  with  the  ovarian  tumor.  It  was 
successful. 

Case  No.  CCLXXIX.  I  have  called  a  recovery  with 
a  question  mark.  The  operation  was  done  on  May  20, 
1887;  from  May  23d  till  June  13,  twenty-one  days,  her 
temperature  was  normal  and  her  pulse  was  generally 
between  70°  and  80°  ;  her  appetite  was  good.  On  June 
13,  she  awoke  early  and  demanded  an  early  breakfast, 
and  eat,  perhaps  inordinately,  of  bread,  oatmeal,  and 
hashed  veal  stewed  in  butter.  An  hour  later  she  had 
the  juice  of  an  orange.  At  10,  A.  M.,  she  complained 
of  severe  pain  in  the  stomach,  and  later  vomited.  Her 
temperature  rose  to  105°,  and  her  pulse  to  174"^,  and  she 


23 

died.  There  was  no  autopsy.  The  patient  was  a  hun- 
dred miles  or  more  from  Boston,  and  I  am  at  a  loss  to 
account  for  the  sudden  death.  Her  sister  and  husband 
thought  it  was  severe  indigestion  caused  by  the  veal.  It 
is  unfortunate  that  there  was  no  autopsy. 

Case  No.  CCLXXXV.  I  have  also  called  a  recovery 
with  a  question  mark.  For  three  days  after  the  opera- 
tion, her  temperature  was  about  ioi°.  pulse  ioo°,  but 
from  that  time  on  pulse  and  temperature  were  both  nor- 
mal. Drainage  tube  removed  on  sixth  day.  On  the 
sixteenth  day  after  operation,  she  sat  up  out  of  bed 
for  the  first  time.  After  being  up  for  about  three  quar- 
ters of  an  hour,  she  complained  of  difficulty  in  breath- 
ing, which  rapidlv  increased;  she  grew  purple  in  the 
face,  and  died  in  an  hour  from  her  seizure.  Autopsy 
showed  both  lungs  filled  with  emboli,  completely  occlud- 
ing the  air  passages.  The  origin  of  the  embolism  was 
not  discovered.  She  had  complained  of  some  pain  in 
her  legs,  not  an  uncommon  symptom  after  Ovariotomy, 
but  there  never  had  been  any  swelling.  A  careful  ex- 
amination of  the  femoral  arteries  failed  to  show  any 
starting-point  for  the  trouble. 


CHAPTER   III. 

CYSTS,     STITCHED      TO      SKIN,      UNCOMPLICATED     EXCEPT 
BY     ADHESIONS. 

CYSTS,      COMPLICATED      WITH       OTHER       DISEASES,      AND 
STITCHED     TO     SKIN. 

I  have  been  very  agreeably  disappointed,  of  late 
years,  in  the  results  following  the  drainage  of  ovarian 
cysts  which  could  not  be  removed.  I  think  1  have 
stitched  adherent  ovarian  or  parovarian  cysts  to  the 
edges  of  the  incision,  and  have  drained  them  and 
syringed  them  out  patiently  for  several  weeks  eight 
times,  and  of  these  cases  all  have  recovered. 

The  first  of  these  cases  was  operated  upon  in  the 
centre  of  Massachusetts,  and  I  had  nothing  to  do  with 
the  after  treatment.  The  drainage  tube  was  removed 
soon,  and  the  patient  recovered  and  gained  flesh  and 
strength,  but  in  less  than  a  year  the  growth  increased, 
or  a  new  tumor  was  produced,  and  an  attempt  to  remove 
this  tumor  resulted  fatally. 

The  second  case  was  much  relieved,  but  died  subse- 
quently of  cancer  of  uterus  and  liver,  which  existed 
probably  at  the  time  of  the  laparotomy. 

The  third  case  was  one  of  the  broad  ligament,  com- 
plicated with  tubercular  peritonitis,  and  the  patient  is 
now,  three  years  after  operation,  well  and  strong. 

The  fourth  case  was  one  of  adherent  papilloma,  the 
opening  never  entirely  closed,  and  the  patient  subse- 
quently died  of  consumption  a  few  months  after  opera- 
tion. 

The  fifth  case  was  one  of  the  right  broad  ligament, 
and  the  patient  is  now  well,  two  years  after  operation. 


^5 

The  sixth  case  is  now  in  good  health,  stout  and  strong. 
There  is  still  a  sinus,  with  a  pin-hole  opening,  discharg- 
ing a  drachm  or  two  of  pus  a  day. 

The  seventh  case,  one  of  double  ovariotomy  and 
stitching  the  cyst  of  the  left  ovary  to  the  skin,  recovered, 
contrary  to  my  expectations,  and  is  now  well. 

The  eighth  case  also  recovered. 

Cases  of  Tumors  corn-plicated  with  other  Diseases,  and 
in  zuhich  the  Cysts  were  stitched  to  the  Skin. 

Of  these  there  are  seven,  all  fatal. 

The  first  case  was  one  of  uterine  cyst  of  large  size  ; 
both  ovaries  had  been  removed  on  account  of  cystic  dis- 
ease two  years  previously.  The  patient  died  on  the 
thirteenth  day  after  the  operation  of  Septicaemia. 

The  second  case  was  one  of  ovarian  tumor  and  uterine 
tumor.  The  ovarian  tumor  weighed  forty-five  pounds, 
and  when  this  had  been  removed  a  large  uterine  fibro- 
cyst  came  into  view.  This  latter  was  opened,  emptied, 
and  as  it  could  not  be  removed,  its  edges  were  sewn  to 
the  skin  and  drained.     Death  occurred  on  the  fifth  day. 

The  third  case  recovered  so  as  to  leave  hospital  and 
go  home,  but  died  soon  afterwards  ;  the  tumor  was  a  very 
adherent  one  of  uncertain  origin.  There  was  no  au- 
topsy. 

The  fourth  case  was  one  of  malignant  uterine  tumor, 
irremovable.  The  operation  was  fatal  on  the  second  day 
from  shock. 

The  fifth  case  was  one  of  extra-uterine  pregnancy  of 
seven  years'  duration.  The  cyst  was  emptied  of  about 
four  pounds  of  offensive  yellowish-green  fatty  fluid,  and 
the  complete  skeleton  of  an  adult  foetus.  The  case  is 
reported  in  the  Boston  Medical  and  Surgical  Journal, 
Vol.  CXIV,  page  457,  and  the  bones,  beautifully  mounted 
by  Dr.  O.  K.  Newell,  are  in  the  Warren  Museum. 

4 


26 


The  sixth  case  was  one  of  adherent  ovarian  tumor 
complicated  with  a  uterine  fibroid.  The  latter  was  re- 
moved, the  stump  being  treated  intra-peritoneally.  The 
case  was  rapidly  fatal. 

The  seventh  case  was  one  of  tubo-ovarian  cyst,  with 
hydrosalpinx  on  the  other  side,  chronic  pelvic  peritonitis, 
fibro-myoma,  and  polypus  of  the  uterus.  The  tubo- 
ovarian  cyst  was  punctured  and  stitched  to  the  skin.  At 
the  autopsy,  purulent  peritonitis,  granular  degeneration 
of  the  kidneys,  and  the  affections  above-mentioned  were 
found.     Death  occurred  on  the  thirteenth  day. 


CHAPTER  IV. 

LAPAROTOMIES  FOR  THE  REMOVAL  OF  UTERINE 
TUMORS. 

My  hysterectomies  and  removal  of  uterine  tumors 
number  twenty-seven.  It  will  be  seen  that  although  the 
record  is  not  brilliant,  and  does  not  compare  in  any  way 
with  Dr.  Keith's  wonderful  list,  yet  out  of  the  last  seven- 
teen, fourteen  recovered,  and  none  of  the  cases  were 
done  except  for  the  reason  that  life  was  a  burden,  and 
death  was  impending.  Familiarity  with  the  operation 
has  made  me  more  skillful. 

Case  No.  III.  Was  a  supra-vaginal  remov^al  of  a 
two-horned  uterus  (uterus  bicornis),  one  horn  of  which 
was  dilated  and  did  not  communicate  with  the  vagina. 
A  number  of  pounds  of  dark,  bloody  fluid  was  contained 
in  this  cavity  and  in  the  distended  fallopian  tube.  The 
stump  was  treated  extra-peri toneally,  and  convales- 
cence was  rapid.  The  patient's  age  was  eighteen.  She 
is  now,  four  years  after  the  operation,  well  and  working 
hard.  The  operation  was  done  to  relieve  agonizing 
pain. 

Case  No.  VII.  Is  a  very  remarkable  one,  in  which 
four  pounds  of  tumor  which  could  not  be  removed  at  the 
time  of  the  operation,  was  gradually  extruded  through 
the  wound  after  the  wire  of  the  serre-noeud  had  come  off. 
The  patient  w^as  a  married  woman  36  years  old ;  never 
pregnant.  The  tumor  reached  above  the  umbilicus  and 
was  mostly  on  the  left  side.  Menorrhagia  was  contin- 
uous, and  at  times  violent,  and  had  been  going  on  for 
eight  years,  and  was  attended  with   excruciating   pain. 


28 


Laparotomy  was  done  on  the  12th  of  June,  1884.  The 
tumor  had  grown  under  and  into  the  left  broad  ligament; 
the  intestine  was  adherent  to  the  apex  of  the  tumor. 
Koeberle's  serre-noeud  was  adjusted  around  the  growth 
and  the  wire  pushed  down  into  the  pelvis  as  far  as  pos- 
sible. The  loop  had  above  it  the  right  ovary  and  tube, 
but  not  the  left,  and  the  latter  I  was  not  able  to  feel. 
The  wire  was  tightened  as  much  as  possible,  and  when 
screwed  home  another  serre-nceud  was  put  on  and  the 
first  one  was  removed.  This  case  showed  the  advantage 
of  always  having  two  serre-noeuds  and  induced  me  to 
get  one  with  a  longer  screw.  When  I  could  compress 
no  longer,  I  passed  a  long  pin  through  the  stump  to  keep 
it  outside.  Only  about  half  the  tumor  was  removed,  the 
left  side  of  the  pelvis  being  still  filled  with  the  growth. 
The  top  of  the  uterine  cavity  was  opened.  The  clamp 
came  away  on  the  fifth  day.  And  now  began  the  very 
remarkable  course  of  this  case,  which  had  so  far  been 
like  so  many  others.  The  remaining  portion  of  the 
tumor  began  to  push  out  of  the  abdominal  wound  through 
the  hole  left  by  the  stump,  and  as  it  rapidly  grew  larger 
and  larger,  elastic  ligatures  were  tied  around  its  base, 
daily,  on  and  after  July  15.  On  the  i8th  of  July,  i.  e., 
thirty-two  days  after  the  clamp  had  come  oft',  the  pro- 
truding mass  was  pretty  well  pediculated.  It  was  about 
as  large  as  my  head,  vascular-looking,  and  was  the  por- 
tion of  the  tumor  left  behind  at  the  time  of  the  operation, 
and  had  not  onl}'  been  extruded,  b}'  uterine  contraction  I 
suppose,  but  had  nearly  doubled  in  size.  I  now  tied  a 
strong  ligature  of  silk  around  the  base  of  the  tumor  and 
cut  the  protruding  part  away  with  strong  scissors.  The 
tumor  removed  weighed  four  po7uids.  Some  constitu- 
tional shock,  vomiting,  and  a  rise  of  temperature  followed 
the  removal  of  the  tumor,  but  this  soon  subsided.  In  Jan- 
uary, 1885,  she  was  well,  fat  and  free  from  pain,  and  has 
continued  so  ever  since.     In  February,  1885,  occurred  the 


last  uterine  flow,  and  nothing  has  been  seen  since.  The 
body  of  the  uterus  covered  with  a  smooth  cicatrix  comes 
up  against  the  abdominal  scar  at  the  seat  of  the  incision, 
and  there  is  now  a  small  ventral  hernia  below  it.  So 
far  as  I  know,  this  case  is  unique,  though  I  do  not  know 
why  the  uterus  should  not  be  able  to  squeeze  out  a  fibroid 
through  an  incision  from  above,  as  well  as  through  one 
made  from  the  vagina.  This  case  I  watched  with  great 
interest,  and  the  outcome  has  been  very  fortunate,  for 
these  partial  removals  of  uterine  tumors  are  apt  to  be 
unfortunate  in  their  terminations. 

Case  No.  XIII.  Was  one  of  the  few  in  which  drain- 
age was  used  after  hysterectomy.  The  patient  was  30 
years  old,  and  the  tumor  was  the  size  of  an  adult  head. 
She  is  now  (July,  1887)  well  and  strong. 

Case  No.  XXIV.  Besides  being  a  large  tumor  (38 
pounds),  is  remarkable  for  its  happy  result,  the  top  of 
the  bladder  having  been  taken  off  by  the  serre-noeud. 
The  wire  came  away  on  the  third  day,  and  the  urine 
flowed  from  the  wound,  only  a  little  remaining"  in  the 
bladder ;  after  various  plans  had  been  tried,  I  finally 
decided  to  keep  a  Sims'  self-retaining  catheter  in  the 
bladder  continuously.  This  was  done  successfully  with- 
out any  cystitis  ;  the  hole  filled  up  very  slowly,  its  healing 
being  retarded  by  occasional  overflows  of  urine,  but  at 
length,  after  about  seven  weeks,  the  patient  went  home 
with  the  sinus  solidly  healed  and  able  to  retain  her  urine 
the  normal  length  of  time. 

Case  No.  XXVI.  The  operation  in  this  case  restored 
a  patient  to  a  life  of  comfort,  and  relieved  her  of  great 
suffering  and  debility.  The  patient  was  a  married 
woman  51  years  old;  she  had  had  three  children,  of 
whom  the  youngest  was   15.     In  appearance   she  was 


very  pale  and  aneemic.  Her  flowing  had  always  been 
excessive  except  during  the  year  1882.  when  electrolysis 
had  been  employed  and  masses  of  sloughing  tissue  had 
passed  out  of  the  uterus  into  the  vagina  with  great  pain. 
Her  tumor,  which  at  that  time  was  the  size  of  a  cocoa- 
nut,  entirelv  disappeared  after  the  electrolysis,  and 
although  ver}^  ill  for  many  weeks  she  recovered  and  was 
comfortable,  so  far  as  the  menorrhagia  was  concerned, 
for  a  year.  In  1883  the  flowing  and  pain  recommenced 
and  have  kept  on  increasing.  February  12.  1887, 
hysterectomy  was  done,  the  stump  being  treated  extra- 
peritoneallv.  At  that  time  the  woman  was  very  pale 
from  excessive  flowing,  there  was  a  mitral  murmur,  her 
left  leg  was  swollen,  she  was  short  of  breath  and  had 
constant  abdominal  pain.  The  operation  was  simple, 
except  that  three  wires  broke  while  being  tightened. 
Recovery  was  rapid  and  she  went  home  free  from  pain. 


CHAPTER  V. 

REMOVAL    OF    UTERINE    APPENDAGES    FOR    FIBROID 
TUMORS. 

Case  No.  I.  A  married  woman  33  years  old.  I 
thought  the  tumor  ovarian  from  its  apparent  fluctuation. 
At  the  operation,  October  15.  1884,  the  tumor  was  found 
to  be  the  uterus  symmetrically  enlarged  and  looked  like 
the  impregnated  uterus.  It  was  apparentl}^  full  of  fluid, 
but  none  could  be  obtained  by  aspiration.  When  the 
abdomen  was  opened  the  tumor  was  tense,  but  when  the 
operation  was  finished  it  was  quite  flaccid  ;  both  ovaries 
and  tubes  were  removed  ;  there  was  a  slight  quantitv  of 
ascitic  fluid.  Her  monthly  sickness  has  been  profuse  at 
times,  and  there  has  been  more  or  less  constant  slight 
flowing  for  weeks.  A  serious  flooding  spell  occurred  in 
June.  1886,  since  which  time  the  catamenia  have  ceased. 
The  tumor  is  now  (July,  1887)  rather  smaller  than  it 
was  three  years  ago. 

Case  No.  H.  Was  a  great  success.  The  patient 
was  a  married  woman  44  years  old.  Catamenia  always 
irregular.  At  times  she  has  been  in  Insane  hospitals, 
and  has  had  delusions.  At  each  menstrual  period  she  is 
very  violent  and  suffers  greatlv.  Has  had  several  at- 
tacks of  severe  uterine  hemorrhage  requiring  plugging. 
The  abdomen  was  very  tender,  and  was  occupied  by  a 
tumor  which  was  solid  and  extended  from  the  cavity  of 
the  pelvis,  which  it  nearly  filled,  to  the  umbilicus.  She 
stated  that  she  could  no  longer  bear  the  continual  pain 
and  the  monthly  agony  of  menstruation.  A  few  ounces 
of  serum  ran  out  on  opening  the  abdomen,  January  18, 
1885,  and  the  tumor  above-mentioned  came  into  view. 


32 

It  was  a  uterine  fibroid.  The  ovaries  and  tubes  were 
easily  seized  and  removed.  She  recovered  rapidly. 
Her  depression  left  her,  she  was  free  from  pain,  men- 
struation entirely  ceased,  and  the  tumor  diminished  in 
size  rapidly.  On  September  i8,  she  came  to  my  office, 
bright  and  well  ;  I  could  not  feel  the  tumor  b}'  external 
examination.  She  was  very  grateful,  and  had  been 
cured  not  only  of  the  tumor,  but  of  her  mental  troubles. 
She  is  still  (July,  1887)  in  perfect  health. 

Case  No.  III.  Was  a  case  of  removal  of  the  ap- 
pendages for  great  hgemorrhage  accompanying  a  fibroid, 
about  the  size  of  a  large  orange,  in  a  patient  34  vears 
old.  The  patient  was  very  much  blanched.  She  had 
known  of  the  existence  of  the  tumor  for  three  years. 
The  abdomen  was  opened  August  25,  1885.  The  omen- 
tum came  into  view,  and  under  it  was  a  symmetrical 
round  fibroid  filling  the  pelvic  brim.  With  considerable 
difficult}'  and  force  the  uterine  appendages  were  dragged 
up  and  removed.  I  could  not  get  a  sponge  down  be- 
tween the  pelvic  brim  and  the  tumor,  and  so  could  not 
sponge  out  the  pelvis.  The  patient  recovered  rapidl}^ 
May  13,  1886,  she  was  well  and  strong,  and  had  gained 
twenty-four  pounds  of  flesh.  For  three  months  after  the 
operation  she  had  flowed  unceasingly,  but  the  whole 
amount  was  nothing  to  what  she  formerly  had  at  one 
menstruation.  From  November,  1885,  till  February, 
1886,  the  flowing  wholly  ceased  ;  then  she  began  to  flow 
and  continued  to  do  so  till  May,  1886,  since  wliich  time 
I  have  not  seen  her.  From  August,  1885,  till  May, 
1886,  i.  e.,  nine  months,  she  said  she  had  not  lost  one 
tenth  part  of  the  blood  she  lost  during  the  preceding 
nine  months. 

Case  No.  IV.  Was  one  of  extreme  anaemia  and  suf- 
fering.    I  had  to  pull  the  tumor  out  of  the  abdomen  to 


33 

get  at  the  ovaries,  and  then  found  them  imbedded  in  the 
tumor.  I  dug  them  out  and  tied  the  pedicles,  and 
pushed  the  tumor  back.  The  whole  operation  required 
much  force,  and  hysterectom}^  ought  to  have  been  done 
instead.     The  patient  died  on  the  third  day. 

Case  No.  V.  A  married  woman  36  years  old. 
Had  been  flowing  freely  for  fourteen  3"ears,  and  now 
worse  than  ever.  There  was  a  fibroid  about  the  size  of 
an  ordinary  orange.  Both  ovaries  and  parts  of  both 
tubes  removed  on  January  21,  1886.  She  recovered 
rapidly,  the  uterine  flowing  has  been  unchecked,  and  in 
December,  1886,  when  I  last  heard  from  her,  she  was 
much  discouraged,  and  was  flowing  as  badl}^,  if  not 
worse,  than  before  the  operation. 


CHAPTER   VI. 

REMOVAL    OF    UTERINE    APPENDAGES    FOR    THE    CURE 
OF    NERVOUS    DISORDERS. 

Case  No.  I.  I  saw  the  patient,  a  single  young  lady 
22  years  old,  in  March,  1883.  Briefly  her  previous  his- 
tory was  the  following:  —  She  was  taken  ill  in  ]March. 
1877.  and  has  since  been  most  of  the  time  in  bed,  suffer- 
ing severe  pain  in  the  let't  ovarian  region.  Her  menstru- 
ation had  always  been  irregular,  and  was  accompanied. 
at  times,  by  sudden  severe  spasmodic  pain  in  the  left  iliac 
fossa.  These  attacks  were  accompanied  by  confusion  of 
ideas,  and  severe  pain  and  tenderness  along  the  spinal 
column.  At  one  time,  she  became  to  all  appearance  in- 
sane, at  times  melancholy,  at  others  destructive,  and  again 
abusive  ;  her  whole  body  at  times  became  rigid.  (Hys- 
teria.) This  state  of  things  lasted  for  about  six  weeks. 
when  she  returned  suddenly  to  a  normal  state  of  mind,  and 
became  bright  and  intelligent.  After  a  few  months  she 
became  ill  again,  and  complained  of  the  pain  mentioned 
above  as  being  very  exquisite.  The  least  touch  on  the 
left  side  of  the  abdomen  seemed  to  cause  pain.  Spec- 
ialists in  cerebral,  nervous,  and  uterine  diseases  were 
consulted.  The  general  conclusion  was  reported  to  me 
as  being  that  she  might  obtain  some  relief  from  palliative 
measures.  Morphia  was  given  to  her  and  she  became 
addicted  to  the  use  of  the  drug.  She  was  for  three 
months  in  a  Water-cure  establishment  in  Maine,  in  1879. 
In  January,  1881,  she  went  to  the  Adams  Nervine  As}''- 
lum  in  Boston,  and  remained  four  months.  In  May, 
1882.  she  went  to  Dr.  Ring's  Sanitarium  at  Arlington 
Heights,  near  Lexington.  Mass.,  and  I  saw  her  there. 
During  these  seven  years  there  were  some  months  when 


35 

she  could  be  partly  about  the  house,  but  most  of  the 
time  she  was  in  bed.  The  uterus  was  very  small  and 
undeveloped,  and  an  imperfectly  defined  body  near  the 
posterior  portion  of  the  cervix,  on  the  left  side,  was 
thought  to  be  possibly  a  prolapsed  ovaiy.  Pressure  on 
this  substance  caused,  apparently,  agonizing  pain.  Re- 
moval of  the  ovaries  was  suggested  to  her,  and  she  ea- 
gerly desired  it  to  be  done  if  there  was  a  shadow  of  hope 
that  it  would  benefit  her.  After  hearing  this  history, 
and  consulting  with  Drs.  J.  T.  G.  Nichols,  Ring,  and 
Westcott,  I  agreed  with  them  that  removal  of  the  ovaries 
would  be  a  justifiable  procedure,  a  safe  operation  and 
perhaps  beneficial. 

The  operation  was  done  March  26,  1883.  Her  con- 
valescence was  normal,  except  that  the  left  parotid  gland 
became  swollen  on  the  fourth  day,  but  this  gradually  sub- 
sided. At  the  end  of  two  weeks  she  could  walk  about, 
and  she  went  home  at  the  end  of  six  weeks.  Her  mind 
had  become  perfectly  clear.  The  pain  and  soreness  in 
the  left  iliac  region  had  nearly  gone,  and  she  felt  very 
glad  that  the  operation  had  been  done.  So  far  as  I 
could  see  there  was  nothing  remarkable  about  the  ova- 
ries and  tubes  removed.  One  of  the  ovaries  was  smaller 
than  the  other,  and  both  contained  small  cysts ;  the 
lining  of  the  Fallopian  tubes  was  fatty,  but  there  was 
nothing  to  account  for  all  the  pain  and  nervous  phenom- 
ena. The  immediate  relief  of  the  operation  was  great, 
and  for  about  a  year  the  patient  was  very  comfortable, 
but  not  strong.  She  never  has  had  any  of  the  old 
severe  pain  in  the  iliac  region,  and  the  relief  from  this 
seems  to  be  due  to  the  moral  or  physical  effect  of  the 
operation,  at  any  rate  to  the  operation.  In  1884,  she 
had  a  time  when  her  hysterical  symptoms  returned,  and 
she  recommenced  the  use  of  morphia,  but  this  was  again 
given  up  and  she  recovered.  ,  In  answer  to  a  circular 
sent  in  December,  1886,  she  writes,  after  saying  that  she 


36 

has  never  menstruated,  •'  The  operation  was  very  suc- 
cessful in  its  resuhs.  excepting  an  adhesion  to  the  bowels 
and  great  trouble  with  constipation.  Up  to  a  year  ago 
last  summer  (i.  e.,  1885),  my  health  was  better  than  for 
years,  but  owing  to  overwork,  and  a  fall  which  injured 
the  spine,  I  have  been  confined  to  my  bed  ever  since 
that  time."  Of  course  she  does  not  know  whether  there 
is  an  adhesion  or  not.  but  she  does  know  that  there  is 
constipation.  Now.  looking  at  the  present  condition  of 
the  patient,  in  bed  and  confined  to  her  bed  now  for  two 
years  past,  I  cannot  see  that  the  operation  has  been  of 
much,  if  any,  permanent  good,  though  I  ought  in  fairness 
to  say  that  she  and  her  family  feel  that  it  has  been  very 
beneficial. 

Case  No.  II.  This  case  is  a  brilliant  one.  The 
patient  was  19  vears  old.  In  her  childhood  she  was 
easily  excited  and  not  easily  managed,  subject  to  par- 
oxysms of  temper,  in  which  she  would  scream,  throw 
herself  about,  break  furniture,  and  tear  her  clothing. 
At  eight  or  nine  3'ears  old,  she  was  found  bathing  with 
boys,  naked,  and  she  said  she  had  frequentl}'  had  con- 
nection with  older  boys.  She  was  sent  to  various  Homes 
and  Schools,  but  could  not  be  made  to  mind.  At  length, 
at  p  vears  of  age,  she  was  sent  to  the  Taunton  Insane 
Asylum,  where  she  remained  tour  years.  Here  she  was 
very  violent,  noisv  and  destructive,  perfectly  reckless  of 
personal  injur}'',  throwing  herself  headlong  down  flights 
of  stairs,  if  an  attempt  was  made  to  secure  her.  At  the 
end  of  four  years,  she  was  removed  to  the  Asylum  for 
the  Chronic  Insane  at  Worcester.  After  studying  the 
case  for  a  year,  and  with  the  consent  of  her  mother,  per- 
sonal chastisement  was  tried,  at  first  with  good  efiect. 
She  went  home  from  Worcester  in  May,  1880,  and 
behaved  admirably  for  four  months.  At  this  time  she  was 
sixteen    vears    old.     In    October,    after    a    scantv  men- 


37 

strual  flow  attended  with  considerable  pain,  she  began 
to  complain  of  her  head,  and  appear  nervous.  After  a 
Tew  days,  being  agitated  by  the  lact  that  her  mother 
had  found  she  wns  studying  surreptitiously,  contrary  to 
her  wishes,  she  rushed  to  the  second-stor}^  window,  and 
in  an  instant  had  jumped  from  the  roof  of  a  veranda, 
and  was  found  screaming  and  maniacal  on  a  walk  below. 
She  was  now  sent  to  Danvers  Asylum,  with  hallucina- 
tions of  sight  and  hearing.  Dr.  Goldsmith  in  reporting 
her  case  *  says.  "  Since  October  14,  1880,  she  has  been 
a  patient  at  the  Danvers  Hospital,  where  she  has  en- 
gaged the  sympathy  and  exhausted  the  resources  of 
treatment,  medical  and  moral,  of  every  one  who  has 
come  in  contact  with  her."'"  Not  to  make  this  account  too 
long,  I  will  say  that  Dr.  Goldsmith  decided  to  try  the 
effect  of  removing  the  ovaries,  and  I  did  the  operation 
July  20,  1883.  Recover}'  was  rapid.  She  left  the  Asy- 
lum at  the  end  of  four  weeks,  and  has  since  that  time, 
for  lour  years,  been  at  home  perfectly  well,  living  the 
same  life  as  the  other  members  of  the  family.  She  has 
not  menstruated  since  the  operation.  A  perusal  of  Dr. 
Goldsmith's  paper,  which  has  been  reprinted  with  the 
title,  "  A  Case  of  Moral  Insanity."'  will  well  repay 
the  reader. 

Case  No.  III.  Was  an  utter  failure.  The  patient 
was  a  married  woman,  27  3'ears  old,  formerly  a  school 
teacher.  At  about  24  years  of  age  she  was  married  ; 
within  a  few  weeks  unmistakable  signs  of  mental  de- 
rangement appeared ;  she  attempted  suicide  b}'  drown- 
ing and  was  sent  to  an  Asylum.  She  was  a  very  violent 
patient.  When  I  saw  her  she  was  craz\'  and  more  or 
less  demented.  The  Superintendent,  from  whose  Asylum 
she   came,   said  that   any  operation  would  be   perfectly 

*  American  Journal  of  Insanity.  October.  18S3. 


38 

useless,  but  her  physician  was  convinced  that  her  excite- 
ment was  more  at  the  menstrual  period,  and  that  her 
insanity  was,  more  or  less,  connected  with  the  sexual' 
organs.  But  the  Superintendent  was  right.  She  recov- 
ered rapidly  from  the  removal  of  the  ovaries  and  tubes, 
on  December  13.  1S83.  She  was  kindly  cared  for  at 
the  McLean  Asylum  for  more  than  a  year,  and  was 
neither  better  nor  worse  mentally.  She  destroyed  every 
thing  she  could,  broke  windows,  and  struck  her  attend- 
ants, and  was  demented.  She  died  of  Phthisis,  in  the 
Worcester  Lunatic  Hospital,  in  1886.  never  having 
menstruated  since  the  operation.  Her  case  show^ed  how^ 
unnecessary  perfect  quiet  is  after  laparotomy,  for  she 
had  to  be  tied  to  the  bed  and  frequently  broke  all  the 
fastenings,  and  the  straps  of  the  Crosby  bed  on  which 
she  lay,  and  yet  the  wound  united  by  the  first  intention, 
and  she  never  had  hernia. 

Case  No.  IV.  Another  perfect  failure,  as  far  as 
relief  and  cure  are  concerned.  Her  s}'mptoms  ^\■ere 
pain  and  tenderness  in  the  left  iliac  region  ever  since 
she  could  remember,  worse  on  exertion  or  on  standing. 
Catamenia  regular,  painful.  Married  seventeen  years, 
no  children.  Appetite  poor.  Went  to  the  Adams  Ner- 
vine Asylum,  and  remained  five  months,  came  home 
more  ner\ous,  weak,  and  hysterical.  Dr.  Chamberlain, 
of  Lawrence,  found  a  tender  spot  and  a  body  in  Doug- 
lass space,  that  he  thought  might  be  a  displaced  ovary. 
She  stated  that  her  life  was  a  perfect  burden,  on  account 
of  general  illness,  hyperaesthesia,  pain  in  back,  in 
hands,  etc.,  and  she  thought  that  all  her  symptoms 
seemed  to  originate  in  her  side  and  to  the  pain  that  she 
felt  between  the  umbilicus  and  the  pubes.  After  etheri- 
zation, her  case  reminded  me  of  Case  No.  I,  which  had 
been  improved  so  much  at  first.  Both  ovaries  were 
removed  on  August  24,  1885,  but  not  the  whole  of  both 


tubes.  Nothing  especially  remarkable  was  found  on 
examination  of  the  ovaries.  She  recovered  rapidly, 
and  has  suffered  nearly  all  the  time  since  as  she  did 
before  the  operation,  on  the  whole,  perhaps,  in  a  milder 
degree.  She  menstruates  regularh'  every  22  days,  and 
menstruation  is  accompanied  by  much  pain. 

Case  No.  V.  Was  another  case  of  hystero-mania 
with  morphia-eating,  in  a  single  woman  aged  28.  The 
history  corresponds  somewhat  with  that  given  in  detail 
in  Case  No.  I.  The  ovaries  and  tubes  were  removed 
November  25.  1885.  She  recovered,  and  wrote  that  she 
was  getting  well  and  beginning  a  ••  new  life,"'  and  that 
the  past  had  been  a  '■  night-mare."  or  •■  horrid  dream." 
Her  menstruation  is  irregular,  but  occurs  about  ever}^ 
three  weeks.  I  cannot  learn  (July,  1887)  that  she  is 
any  better  than  before  the  operation.  On  the  whole,  I 
cannot  say  that  my  experience  with  these  five  cases 
would  lead  me  to  advise  removal  of  the  uterine  appen- 
dages for  the  cure  of  nervous  symptoms  and  hj'steria, 
unless  the  operation  were  advised  by  a  competent  alien- 
ist. I  acted  in  these  cases  as  an  instrument  in  the  hands 
of  others. 


CHAPTER  VII. 

EXPLORATORY  LAPAROTOMIES. 

Case  No.  I.  Was  in  a  lady  62  years  old,  so  large 
that  I  could  make  no  decided  diagnosis,  and  in  whom 
respiration  could  not  be  carried  on  in  a  recumbent 
position.  I  had  to  kneel  down  and  cut  upwards  while 
the  patient  lay  on  her  side.  About  forty  pounds  of 
ascitic  fluid  was  removed,  and  a  soft,  friable  tumor 
attached  to  the  sacrum  and  riffht  ilium  was  found. 
It  was  impossible  to  remove  the  tumor.  The  abdomen 
was  thoroughly  sponged  out  and  the  wound  sewn  up. 
The  patient  recovered  rapidly  and  was  much  relieved. 
The  ascitic  fluid  never  reaccumulated.  About  a  year 
afterwards  the  patient  died,  and  at  the  autopsy,  a  soft 
sarcomatous  mass,  filling  the  pelvis  and  lower  abdominal 
region,  was  found. 

Case  No.  II.  Was  a  case  of  ascites  and  burst  papil- 
lomatous cyst,  attached  to  the  pubes,  ischium,  and  pelvic 
organs  generally.  The  ascitic  fluid  reaccumulated,  and 
the  patient  died  about  eighteen  months  later,  having 
steadily  refused  to  be  tapped. 

Case  No.  III.  Was  a  solid  adherent  tumor,  whose 
attachments  and  (jrigin  were  not  determined.  The 
patient  recovered,  but  was  not  benefited  nor  harmed  ; 
her  condition  remained  about  the  same.  I  think  she  is 
now  dead,  but  she  lived  some  years. 

Case  No.  IV.  Was  a  case  of  large  malignant  tumors 
of  ovaries,  liver,  omentum,  and  intestinal  organs  gen- 
erally. The  patient  recovered,  and  died  in  March,  1883, 
six  months  after  operation. 


41 

Case  No.  V.  Was  that  of  a  woman  21  3^ears  old, 
with  a  considerable  amount  of  ascitic  fluid  and  many 
little  thin-walled  cysts  attached  to  the  peritoneum  and 
intestines ;  the  pelvis  was  more  or  less  filled  by  a  friable 
tumor  filling  the  right  side.  Its  exact  attachments  were 
not  made  out,  but  it  was  immovable  and  was  not  inter- 
fered with.  The  patient  recovered,  and  during  the  next 
four  years  fell  into  the  hands  of  several  surgeons  who 
tapped  her.  In  1885  she  reported  herself  to  Dr.  J. 
Foster  Bush  as  having  entirely  recovered,  and  that  her 
tumor  had  entirely  disappeared.  If  this  be  true,  the 
growth  must  have  been  syphilitic,  I  think,  perhaps  of 
the  nature  of  a  gumma. 

Case  No.  VI.  One  of  abdominal  cancer.  Recov- 
ered from  the  operation  and  went  home,  but  probably 
did  not  live  long. 

Case  No.  VII.  Was  another  case  of  general  ab- 
dominal cancer  with  ascites,  and  was  fatal. 

Case  No.  VIII.  On  opening  the  abdomen,  ascitic 
fluid  ran  out  and  coagulated  fibrin,  exactly  like  the  co- 
agulated fluid  of  pleurisy  after  it  has  been  removed 
from  the  thorax;  this  was  bailed,  scooped,  and  sponged 
out.  The  omentum  had  become  an  elongated  tumor 
of  a  pinkish  coral  color ;  the  spleen  was  in  the  same 
condition.  There  was  general  cancer.  Neither  the 
uterus  nor  ovaries  could  be  felt ;  they  seemed  to  be  shut 
off  by  a  wall  of  cancer.  Nodules  were  felt  in  the 
mesentery.  The  patient  recovered  from  the  operation, 
and  was  quite  comfortable  for  a  time,  but  died  about 
seven  months  later. 

Case  No.  IX.     Was  one  of  tuberculous    salpingitis, 
with  cheesy  masses  extending  upwards  to  the  diaphragm 
6 


42 

on  both  sides,  and  general  tubercular  disease  of  the  per- 
itoneal tissues  matting  them  together.  The  operation 
was  fatal.     The  age  of  the  patient  was  17  years. 

Case  No.  X.  This  case  was  one  of  tubercular  peri- 
tonitis with  ascites,  in  a  thin,  emaciated,  feeble,  single 
girl  of  21.  What  looked  like  the  stomach  distended 
with  fluid  filled  the  upper  portion  of  the  abdominal 
cavity.  This  tumor  was  about  ten  inches  in  diameter. 
Owing  to  the  presence  of  lymph  and  adhesions,  the  liver 
and  spleen  could  not  be  felt.  Much  hanph  was  lying  in 
masses  and  flakes  upon  the  abdominal  viscera.  There 
were  deposits  of  tubercles  sprinkled  about  on  all  the 
abdominal  contents  seen.  The  wound  healed  b}'  first 
intention,  but  opened  spontaneously  on  the  eighteenth 
day,  and  gave  exit  to  much  clear  serum.  She  went 
home  in  good  spirits,  July  12,  1884.  The  catamenia, 
which  had  been  absent  since  February,  1884,  returned 
in  January,  1885,  and  have  been  regular  since.  The 
wound  continued  to  discharge,  but  the  amount  gradually 
diminished,  until  in  May,  1885,  it  was  very  slight.  She 
became  fat  and  strong,  and  able  to  do  her  housework, 
and  gained  over  thirt}^  pounds  in  weight.  She  was 
married  in  June,  1885.  I  saw  her  in  November,  1886. 
She  was  strong  and  well.  The  wound  had  contracted  to 
a  little  sinus,  which  would  admit  a  probe,  and  which  dis- 
charged about  a  drachm  or  less  of  pus  a  day.  A  won- 
derful recovery. 

Case  No.  XI.  Was  that  of  a  married  woman,  46 
years  old.  Her  abdomen  was  full  of  ascitic  fluid,  and 
contained  a  tumor  reaching  to  the  ensiform  cartilage. 
She  had  been  tapped  five  times  in  four  months.  When 
the  abdomen  was  opened,  about  twenty  pounds  of  ascitic 
fluid  ran  out.  The  parietal  peritoneum  and  that  of  the 
bowels,  mesentery,  and  abdominal  viscera,  was  Cf)vered 


43 

more  or  less  with  cancerous  deposits,  a  few  of  which 
were  removed  for  microscopic  examination.  The  left 
ovary  was  a  tumor  about  the  size  of  a  large  football,  and 
was  covered  with  adherent  intestines,  and  with  the 
growths  above  mentioned.  It  was  impossible  to  remove 
the  tumor,  and  the  cancerous  condition  of  the  peritoneum 
seemed  to  preclude  complete  recovery.  Two  large 
india-rubber  drainage  tubes  were  put  in  on  either  side, 
and  another  small  one  in  the  pubic  region,  with  the 
hope  of  establishing  permanent  drainage.  In  the  first 
twelve  hours  much  fluid  was  discharged,  but  this  grad- 
ually ceased,  and  in  a  few  days  all  the  tubes  were 
removed.  I  have  never  succeeded  in  establishing  per- 
manent drainage  in  ascites  by  means  of  tubes,  and  I 
never  expect  to.  The  track  of  the  tube  becomes  sur- 
rounded with  lymph,  and  the  only  portion  of  the  perito- 
neal sac  drained,  is  that  tubular  portion  in  which  the 
drain  lies.  Sometimes,  as  in  Case  X,  nature  establishes 
drainage  and  cures  the  patient,  but  she  does  this  without 
the  aid  of  tubes.  The  operation  was  done  on  the  3d 
of  January,  1885,  and  she  died  six  months  later. 

Case  No.  XII.  Was  that  of  a  little  girl  ten  years 
old.  The  abdomen  was  found  filled  with  hard  tumors, 
thoroughl}-  adherent  and  immovable.  The  operation 
was  done  July  9,  1885,  and  she  died  on  the  27th  of 
April,  1886,  having  lived  very  comfortably  most  of  the 
time.  The  growth  found  its  way  through  the  skin  of 
the  abdomen  about  three  months  before  death. 

Case  No.  XIII.  Was  one  of  malignant  abdominal 
tumor.     Much  more  comfortable  after  Laparotomy. 

Case  No.  XV.  Was  one  of  small  adherent  tumor 
attached  to  the  brim  of  the  pelvis  on  the  right  side,  and 
to  the  intestines.     It  could  not  be  removed.     The  patient 


44 

recovered  from  the  operation,  and  died  in  July,   1887, 
eight  months  after  recovery  from  the  operation. 

Case  No.  XVL  Was  another  case  of  malignant 
tumor  of  the  omentum  and  peritoneum,  in  which  I  tried 
to  establish  drainage  by  means  of  rubber  tubes,  but  the 
ascitic  fluid  accumulated  in  spite  of  the  tubes.  The 
operation  was  done  November  12,  1886,  and  was  suc- 
cessful so  far  as  immediate  recovery  went,  but  the  patient 
died  some  months  after  her  return  home. 

Case  No.  XVIII.  Had  ovariotomy  successfully  per- 
formed six  years  before.  The  exploratory  operation 
was  done  in  February,  1887,  but  the  tumor  of  the 
remaining  (left)  ovary  could  not  be  removed.  The 
operation  was  fatal. 

Case  No.  XIX.  Was  another  case  of  tubercular 
peritonitis  in  a  fat,  healthy-looking  girl  of  17.  The 
operation  was  successful.  Time  enough  has  not  elapsed 
to  decide  whether  the  abdominal  exploration  will  be 
curative. 


CHAPTER  VIII. 

LAPAROTOMIES    FOR    RENAL    TUMORS. 

Case  No.  I.  A  married  woman  aged  30,  urinary 
symptoms  coming  on  during  pregnancy.  In  1878, 
patient  became  pregnant,  and  when  quite  large,  at  eight 
months,  noticed  gravel  in  the  urine,  and  suffered  from 
sharp,  lancinating  pains  in  region  of  ureter ;  at  times, 
the  pain  was  so  severe  as  to  cause  her  to  faint.  Her 
confinement  was  completed,  and  in  two  years  she 
became  again  pregnant,  and  was  confined  of  a  second 
child.  After  one  of  her  attacks  of  pain,  vomiting, 
cough  and  general  constitutional  disturbance,  she  noticed 
a  swelling  in  the  right  hypochondrium  and  right  lumbar 
region  which  has  increased  since.  At  this  time  her  urine 
was  loaded  with  pus,  and  her  micturition  was  very  fre- 
quent. I  saw  her  in  April,  1882  ;  at  that  time  her  urine 
was  chocolate-colored;  S.  G.,  1033;  much  sediment; 
reaction  acid  ;  albumen  one-half  per  cent.  ;  sediment  pus, 
blood,  hyalin,  and  granular  casts,  and  a  few  fatty  casts. 
Her  fasces  contained  much  blood  and  pus.  A  tumor, 
the  size  of  a  large  cocoanut,  occupied  the  whole  of  the 
right  hypochondrium,  and  reached  nearly  to  the  spine; 
it  was  uniformly  firm  and  tense,  but  fluctuating  and 
movable  as  a  whole.  On  April  19,  a  vertical  incision 
about  three  inches  to  the  right  of  the  umbilicus  was 
made  ;  it  was  about  four  inches  long.  I  came  down  upon 
a  dense  membrane  (the  peritoneum)  covering  the  tumor. 
A  director  was  thrust  in  and  dark,  brownish  fluid  welled 
up  ;  a  free  opening  was  then  made,  and  about  six  ounces 
of  inoffensive  pus  ran  out.  The  kidney  was  then  ex- 
plored by  the  finger,  and  two  calculi,  one  two  inches. 


46 

and  the  other  half  an  inch  in  diameter,  were  removed. 
A  drainage  tube  was  fastened  in,  and  the  wound  dressed 
with  carbolized  gauze.  Vomiting  had  been  one  of  her 
symptoms  for  several  months,  and  was  not  entirely 
relieved  b}^  opening  of  the  abscess,  and  the  removal  of 
the  calculi.  The  blood  and  pus  in  the  alvine  discharges 
ceased,  and  she  became  much  more  comfortable,  and 
could  lie  on  the  right  side  ;  the  abscess  was  washed  out 
daily,  and  at  times,  small  stones  (one-eighth  inch  in 
diameter)  and  gravel  were  brought  out.  On  May  2, 
the  urine  was  pale,  clear,  with  very  little  sediment, 
about  one-half  per  cent,  of  albumen,  and  contained  a 
few  granular  casts,  pus,  and  epithelial  cells.  In  about 
a  fortnight  she  sat  up,  and  eat  pretty  well,  but  continued 
ver}^  weak.  The  tube  was  removed  on  May  14,  as  it 
was  causing  some  soreness  and  the  fistula  seemed  well 
established.  On  the  i6th,  another  tube  was  placed  in 
the  wound.  She  gradually  became  weaker  and  weaker, 
and  never  really  gained  much,  though  the  operation 
relieved  her  for  a  time.  On  May  23d  she  died.  No 
autopsy  was  allowed.  This  patient,  with  serious  disease 
of  the  kidneys,  was  not  a  good  subject  for  any  operation, 
but  to-day,  I  think  I  should  make  the  opening  in  the  loin 
instead  of  along  the  outer  border  of  the  rectus  muscle, 
for  I  think  the  drainage  would  be  better,  though  I  am 
inclined  to  think  the  case  was  a  hopeless  one,  if  any 
case  ought  to  be  considered  so. 

Case  No.  II.  The  case,  one  of  sarcoma  of  the  left 
kidnev,  weighing  three  and  a  half  pounds,  occurred  in 
a  man,  by  occupation  a  seaman,  29  years  old.  His 
symptoms  were  the  discovery  of  the  tumor  in  the  left 
hypochondrium  in  August,  1882,  emaciation,  blood  in 
the  urine  at  times,  pain  in  the  back  and  loss  of  strength. 
After  considerable  study  and  examination,  I  decided  that 


47 

the  tumor  was  renal  sarcoma.  An  incision  was  made 
along  the  course  of  the  left  linea  semilunaris,  and  the 
tissues  divided.  The  empty  descending  colon  was 
spread  out  very  thin  and  stretched  over  the  tumor,  and 
was  not  immediately  recognized  as  such,  and  was  slightly 
wounded  at  the  very  first  incision.  The  opening  was 
sewn  up  with  a  continuous  silk  suture  and  the  operation 
continued.  The  incision  was  carried  downward  near  to 
the  anterior  spine  of  the  ilium,  and  upward  through  the 
cartilage  of  the  tenth  rib  ;  this  incision  was  supplemented 
by  another,  at  right  angles,  through  the  oblique  and  trans- 
versalis  muscles  as  far  as  the  quadratus.  An  incision 
was  then  made  through  the  posterior  layer  wall  of  the 
peritoneum,  and  the  tumor  peeled  out  of  its  bed,  very 
much  as  one  would  pull  out  a  kidney  at  an  autopsy. 
The  renal  vessels  and  ureter  were  then  secured  and  tied, 
and  the  substance  of  the  kidney  cut  through  on  a  level 
with  the  pelvis.  The  seat  of  the  tumor  was  then  cleansed, 
a  rubber  dra'inage  tube  passed  into  the  cavity  from  the 
loin,  and  the  wound  sewed  up.  Almost  no  urine  was 
secreted  after  the  operation,  and  he  died  November  26, 
1883,  two  days  after  nephrectomy,  only  eight  ounces 
of  urine  having  been  drawn  from  the  bladder  in  the 
two  days  following  the  operation.  At  the  autopsy, 
general  peritonitis  and  cloudy  swelling  of  the  right 
kidney  were  found. 

Case  No.  III.  Was  one  of  large  sacculated  right 
kidney  full  of  pus,  in  a  woman  42  years  old.  I  thought 
the  tumor  cancerous.  The  incision  was  along  the  course 
of  the  linea  semilunaris.  The  ureter  was  easily  isolated 
and  secured  in  the  lower  angle  of  the  w^ound.  The 
renal  vessels  were  secured  and  tied,  and  the  kidney 
removed.  I  thought  the  operation  went  off  very  well, 
but  the  woman  died  on  the  third  day  with  suppression  of 


48 

urine.  The  kidney  and  pus  contained  therein  weighed 
loj  pounds.  Onh'  three  ounces  of  urine,  which  was 
chiefly  pus,  was  drawn  from  the  bladder  after  the 
operation.  At  the  autopsy,  there  was  not  the  least  trace 
of  peritonitis,  and  there  had  been  no  hemorrhage. 
I  suppose  the  death  was  due  to  shock  and  suppression 
of  urine. 


CHAPTER  IX. 

MISCELLANEOUS   LAPAROTOMIES. 

Removal  of  two  immense  Lipomas. 

Case  No.  I.  This  tumor  occurred  in  a  man  38  years 
old.  The  tumor  was  first  noticed  in  March,  1881, 
though  it  must  have  existed  long  before  that  date.  The 
tumor  filled  the  abdominal  parietes  and  seemed  to  fluc- 
tuate. It  had  been  aspirated  many  times  without  any 
result ;  it  was  fast  causing  distress  and  entire  inability 
to  work.  On  October  30;  1881,  I  made  an  exploratory 
incision  fifteen  inches  long.  There  were  slight  adhe- 
sions to  the  liver.  The  tumor  was  about  two  feet  long 
in  its  longest  diameter,  and  about  a  foot  long  in  its 
shortest.  It  was  covered  by  peritoneum.  I  pulled  the 
tumor  out  of  the  abdomen  until  I  found  that  its  envelope 
ran  down  towards  the  spinal  column,  and  was  then  re- 
flected upon  the  abdominal  parietes,  i.  e.,  it  was  retro- 
peritoneal. At  the  lower  part  there  were  no  adhesions 
to  the  bladder,  but  the  tumor  seemed  to  have  a  central 
pedicle  next  to  the  spinal  column,  extending  from  the 
neighborhood  of  the  cceliac  axis  downwards  along  the 
lumbar  vertebras.  As  it  was  not  known  what  organs  the 
tumor  might  contain,  and  as  it  was  feared  that  the 
removal  of  it  might  be  fatal  from  shock  and  heemorrhage, 
it  was  decided  to  replace  the  mass,  and  with  great  diffi- 
culty it  was  pushed  back  under  the  peritoneum  and 
abdominal  muscles  and  skin,  and  nearly  one  hundred 
sutures  were  required  to  close  the  incision.  The  patient 
recovered  rapidly,  and  went  home  with  the  wound 
healed.      (This    operation  was    an  exploratory  incision, 

7 


/ 


so 


and  shoulci  have  found  its  place  among  the   exploratory 
operators. ) 

Tj^  ^itient  went  about  travelling  in'  the  horse-cars 
andHgoi^g  where  he  pleased.  He  walked  with  consid- 
er aMepQom  fort,  wearing  a  supporting  sling  which  held 
uj/tne  jtumor  by  straps  passing  over  his  shoulders.  He 
becani^  more  and  more  impatient  to  have  another  attempt 
mad^'to  remove  his  burden,  and  I  reluctantly  and  rather 
against  my  better  judgment  consented  to  try  again. 
He  said,  "You  know  it  is  neck  or  nothing  this  time, 
doctor."  On  the  5th  of  February,  1882,  I  opened  the 
abdomen  by  the  side  of  the  cicatrix  of  the  former  inci- 
sion, and  removed  two  tumors  weighing  fifty  pounds. 
They  were  myxo-lipomas.  The  incision  was  about 
twenty  inches  long,  and  a  transverse  incision  four  inches 
long  was  made  on  the  left  side  just  above  the  umbilicus. 
The  ascending  colon  crossed  the  tumor  transversely. 
The  peritoneal  capsule  of  the  tumor  was  more  or  less 
torn  and  ruptured,  and  the  tumor  was  lifted  up  with 
great  difficulty,  owing  to  its  weight.  The  ascending 
colon  was  separated  from  the  tumor  with  some  difficult}^ 
and  rolled  off,  after  dividing  and  tying  most  of  its 
mesentery.  The  vascular  attachments  of  the  tumor 
were  clamped  and  tied  or  burnt,  from  time  to  time,  as 
was  necessary,  and  the  tumor  was  removed  from  the 
abdomen.  Another  apparently  purely  myxomatous  one 
now  came  into  sight ;  after  some  hesitation  this  was 
removed  also  ;  it  occupied  the  right  liypochondriac  and 
lumbar  region,  the  liver  being  pressed  upwards  and  to 
the  left  into  the  epigastrium.  The  peritoneal  capsule  of 
this  tumor  was  tough  and  strong  ;  some  of  it  was  removed 
with  the  tumor  and  some  of  it  was  left  behind.  All 
bleeding  points  were  now  secured.  Another  tumor 
about  ten  inclies  long  was  now  seen  lying  on  the  abdom- 
inal aorta  and  pulsating  with  it.  This  I  decided  to  let 
alone.     Everything  looked    as  favorable   as    one  could 


51 

expect  after  so  severe  an  operation  ;  not  much  blood  had 
been  lost,  the  pulse  was  85,  and  very  feeble,  but  not 
extremely  so.  The  operation  had  been  thoroughlv  an- 
tiseptic. The  intestine  which  had  been  pushed  off  the 
tumor,  or  rather  from  under  which  the  tumor  had  been 
withdrawn,  was  largely  deprived  of  its  mesenter}^  and 
might  not  be  well  nourished,  but,  with  this  exception, 
affairs  looked  as  promising  as  after  a  severe  successful 
ovariotomy.  The  patient  was  put  in  bed  and  the  foot 
of  the  bed  w^as  elevated.  He  seemed  to  do  ver}^  well 
and  was  conscious  and  comfortable  five  hours  later,  and 
seemed  to  be  getting  along  well.  He  asked  for  a  drink 
of  water,  and  when  it  was  brought  said,  "  I  think  I  am 
going,"  and  died.  The  autopsy  was  very  kindl}"  made 
by  Dr.  Gannett,  who  found  three  tumors  of  various 
sizes  and  the  same  character  as  those  removed,  and  no 
peritonitis. 

Case  No.  H.  Was  exacdy  like  No.  I,  except  that 
the  patient  was  a  female  61  years  old.  I  saw  her  in 
1881,  and  could  not  believe  that  the  tumor  did  not  con- 
tain fluid  until  I  had  aspirated  it  in  many  places  without 
result.  It  fluctuated  and  gave  a  wave  on  percussion, 
but  it  was  solid,  or  at  least  semi-solid.  The  operation 
was  similar  to  the  one  just  described,  and  the  situation 
of  the  tumor  the  same.  The  patient  died  soon  after  the 
completion  of  the  operation.  The  tumor  weighed  35 
pounds.  The  operation  was  done  March  21,  1882. 
These  are  the  only  two  fatty  tumors  within  the  abdomen 
that  I  have  ever  seen. 


A    Case  of  Pelvic  Abscess  of  long  standing  communi- 
cating -with  the  Rectum. 

The    patient    was    a    single  w^oman  thirty  years   old. 
Nineteen    months    before    I     saw    her,    she     had    been 


52 

attacked  \A'ith  pains  in  the  bowels,  abdominal  disten- 
tion, chills  and  fever,  etc.,  i.  e.,  peritonitis.  The  date 
of  this  illness  was  January,  1884.  The  catamenia 
ceased  for  fifteen  months.  On  and  after  March,  1884, 
she  remained  at  home  and  seldom  went  out  on  ac- 
count of  pain  and  discomfort  in  the  pubic  region. 
In  April,  1884,  pus  was  discharged  from  the  rectum 
in  varying  quantities  nearly  every  day.  In  August, 
1884,  I  advised  hot  vaginal  and  rectal  douches,  and 
these  were  continued  twice  a  day  for  six  months.  She 
improved  and  was  able  to  go  out,  and  the  catamenia 
reappeared  in  April,  1885,  and  continued  for  three 
months.  In  June,  1885,  she  began  to  grow  worse  and 
the  pus  increased  in  amount.  On  palpation,  a  mass  of 
induration  was  felt  in  the  pubic  and  iliac  regions.  On 
August  29,  1885,  the  patient  was  etherized,  and  the  rec- 
tum dilated.  An  opening  from  the  rectum  into  the 
abscess  was  found  towards  the  left  at  a  point  as  high  as 
the  finger  would  reach,  and  a  uterine  sound  was  bent 
and  passed  in,  and  the  tip  brought  up  against  the 
abdominal  parietes.  The  tip  of  the  sound  was  cut 
down  upon  and  brought  out  through  the  anterior  abdom- 
inal parietes  at  a  point  in  the  centre  of  a  triangle,  of 
which  the  base  was  a  line  from  the  umbilicus  to  the  left 
anterior  spine  of  the  ilium,  and  the  apex  the  pubes. 
Considerable  offensive  grumous  pus  came  from  the  rec- 
tum. A  rubber  drainage  tube  was  passed  from  the 
abdominal  wound  downwards,  and  out  through  the  rec- 
tum and  anus.  To  the  finger  the  upper  opening  seemed 
to  pass  through  the  mesentery  or  omentum.  In  the  next 
few  days  considerable  pus  was  discharged  from  both 
openings.  For  twenty-four  hours  the  discharge  from 
the  anterior  opening  was  slightly  fascal.  At  the  end  of 
a  week  the  tube  was  shortened  and  drawn  downwards  to 
allow  the  upper  opening  to  close,  tor  fear  of  establishing 
a  permanent  fascal  fistula,  and  the  tube  protruded  from 


53 

the  rectum.  The  presence  of  the  tube  in  the  anus 
became  very  uncomfortable,  and  it  was  removed,  the 
opening  in  the  rectum  being  daily  dilated  with  the 
finger.  The  patient  went  home  September  i6.  On 
November  28,  1885,  I  saw  her  and  she  looked  much 
better  than  at  any  previous  time  during  my  acquaintance 
with  her.  She  had  gained  flesh  and  color.  There  w^as 
still  some  induration  in  the  pelvis,  and  pus  was  occa- 
sionally discharged  from  the  anus.  She  died  of  Acute 
Phthisis  in  July,  1886.  The  lungs  were  filled  with 
tubercles,  in  some  places  softened,  and  at  the  apex  of 
one  was  a  cavity.  The  pelvic  organs  were  matted 
together,  so  that  the  outlines  of  the  generative  organs 
were  lost.  The  abscess  looked  as  if  it  might  have 
been  tubercular,  perhaps  tubercular  salpingitis,  but 
neither  ovary  nor  Fallopian  tube  could  be  made  out, 
and  only  by  the  sense  of  touch,  and  by  incision,  could 
the  body  of  the  uterus  be  made  out. 

Case  of  Laparotomy  for  Perityfhlitic  Abscess. 

[Reported  in  the  New  York  Medical  Record,  Vol.   CXIV,  page  388.] 

A  boy  II  years  old  began  to  have  pain  in  abdomen, 
January  6,  1886,  and  on  January  9,  I  opened  the  abdo- 
men on  a  line  a  couple  of  inches  above  and  a  little 
behind  the  anterior  spine  of  the  right  ilium,  about  four 
inches  from  the  umbilicus  and  six  inches  from  the 
spinous  processes  of  the  vertebras.  I  came  down  on  the 
healthy  bowel,  and  felt  other  coils,  behind  and  below, 
containing  feecal  masses,  or  else  enlarged  glands,  either 
mesenteric  or  lumbar.  These  organs  were  adherent  to 
one  another  by  a  recent  plastic  process,  and  on  poking 
about  with  my  finger  and  carefully  separating  them,  an 
abscess  containing  about  an  ounce  or  more  of  offensive 
(rotten-egg)  smelling  pus  was  opened.     So  far  as  pos- 


54 

sible,  I  kept  the  pus  out  of  the  peritoneal  cavity,  and 
alter  empt3ang  the  abscess,  put  in  a  double  drainage 
tube.  The  abscess  continued  to  discharge  for  about 
four  weeks.     The  boy  is  now  stout  and  strong. 


Cases  of  Intestinal  Obstruction. 

Case  No.  I.  Is  a  sequel  of  Case  No.  56  of  the  ovari- 
otomies, and  is  reported  in  the  Boston  Medical  and  Sur- 
gical Journal,  Vol.  CVII,  p.  413.  The  obstruction  was 
caused  by  annular  stricture  of  the  sigmoid  flexure  of  the 
rectum.  An  artificial  anus  was  established  at  the  lower 
end  of  the  former  scar  in  the  pubic  region.  The  patient 
was  very  comfortable  for  nearly  a  year,  and  died  of 
general  abdominal  cancer  in  November,  1882. 

Case  No.  II.  Was  unsuccessful.  The  obstruction 
was  in  the  splenic  curvature  of  the  colon,  and  the  artifi- 
cial anus  was  made  in  the  coecum.  The  patient  was 
very  stout  and  the  weather  very  hot,  the  mercury  stand- 
ing at  96°  fahrenheit  in  the  shade  at  the  time  of  the 
operation.  (Case  reported  in  Boston  Medical  and  Sur- 
gical Journal,  Vol.  CX,  p.  146,  February  14,  1884.) 

Case  No.  III.  Was  caused  by  a  band  from  a  Meck- 
el's diverticulum  in  a  young  man  of  21,  \\\iO  had  had  a 
fascal  umbilical  fistula  from  birth.  This  case  is  de- 
scribed in  the  American  Journal  of  the  Medical  Sci- 
ences, Vol.  CLXXV,  p.  56.  Suffice  it  to  say  that  I  did 
not  find  the  band,  that  I  relieved  the  obstruction  by  an 
artificial  anus  at  the  umbilicus,  and  that  the  patient  died 
at  the  end  of  a  week. 

Case  No.  IV.  Has  been  described  in  the  Ovariotomy 
Cases,  No.  CCXXII. 


55 

I  can  only  say  that  if  I  had  known  at  the  time  of 
operating  on  Case  No.  Ill,  what  I  know  now,  the  patient 
would  have  had  a  much  better  chance  for  recovery. 
Prof.  Fitz's  paper  has  taught  me  much,  and  I  have  oper- 
ated successfully  for  the  cure  of  a  diverticulum  opening 
at  the  umbilicus,  i.  e.,  the  omphalo-mesenteric  remains 
of  foetal  life. 


La^a7'otomy   for   Pyosal^inx    and   a    case    of    Tubo- 
ovarian    Cyst  filled  with  -pus. 

Case  No.  I.  May  21,  1886.  A  single  woman.  22 
years  old,  plump  and  well-nourished,  has  had  much 
pain  in  the  rectum  and  vagina  since  July,  1885.  Cata- 
menia  normal.  On  examination  a  hard  tumor  was  felt  in 
the  left  pehdc  region  the  size  of  an  apple,  and  the 
tissues  between  the  vagina  and  rectum  were  thickened. 
I  operated  May  21,  1886.  With  some  difficulty  the  left 
ovary  was  pulled  up,  and  a  cyst  the  size  of  an  orange 
was  tapped  and  emptied  of  purulent-looking  fluid.  The 
ovary  and  the  tube,  which  was  the  size  of  the  thumb 
and  filled  with  pus,  were  then  removed,  and  the  pedicle 
tied  man}'  times  on  account  of  bleeding.  The  right 
ovary  was  fixed  between  the  rectum  and  uterus,  and  was 
dislodged  with  great  difficulty.  I  could  not  detach  the 
right  tube.  The  right  ovary  was  about  the  size  of  a 
plum,  and  filled  with  many  abscesses.  The  disease  was 
probably  of  gonorrhoeal  origin.  Drainage  was  used. 
Recovery  was  rapid.  A  suture  was  discharged  some 
months  later.     She  is  now  (Jul}',  1887)  well  and  strong. 

Case  No.  II.  One  of  suppurating  tubo-ovarian  cyst, 
in  a  woman  44  years  old.  Operation  done  December  6, 
1886.  Some  ascites.  Tumor  largely  composed  of  a 
dilated    tube  with    a    communicatincj    sacculated  ovarv. 


56 

About  three  pounds  of  offensive  pus  removed,  and  the 
tumor  was  separated  with  much  violence  from  the  neigh- 
boring parts.  No  pedicle  could  be  found.  The  oper- 
ation lasted  over  two  hours.  Transfusion  was  employed, 
20  ounces  of  warm  solution  of  chloride  of  sodium  being; 
put  into  the  basilic  vein  ;  this  restored  the  pulse  and 
color.  She  died,  however,  about  twenty-six  hours  after 
the  operation.  Very  possibly,  the  origin  was  tubercular 
pyo-salpinx. 


^ted  that  patients  have 


No. 

Health  since. 

Fibroid  seen  at 
Operation. 

Fibn 
ai< 

6 

F 

Excellent. 

No. 

7 

1, 

" 

8 

'^ 

" 

9 

S 

" 

10 

s 

ic 

« 

11 

N 

12 

D 

Poor. 

« 

13 

F 

" 

14 

11 

Excellent. 

" 

1 

15 

W 

« 

16 

Ji 

Excellent. 

" 

17 

Ji 

r 

I 

18 

0 

19 

N 

li 

" 

20 

D 

" 

1 

21 

F(i 

.. 

- 

Antiseptic 

ovariotomies.    ' 

Oar'bolic  Acid  Spray  used.     Sixth  ovariotomy  the  first 

antiseptic 

one.     "Wlien  it  is  not  stated  that 

patients  have  not  answered,  or  have  died,  it  is  kno-vvn  that  they  are  alive. 

""• 

DuUi  of     - 
Operation. 

... 

mod  of  Tumor. 

m.c.  ovary. 

«■— "- 

Childrcu  before. 

™'-'— ■ 

Married  or  Single 

¥„e!r.' 

.up.„. 

Ligatures  lienrd 

Health  Bincc. 

Fibroid  Been  at 

^SU='' 

Twisted  pedicle. 

.O.U,.. 

Drainage. 

AdhcBlons. 

Death  tiubscquciit- 

» 

Fob.      27,  1877. 

1. 

Mu„.>ocu,„cy.. 

Left. 

To.. 

No. 

NO. 

Single. 

Long. 

Te.. 

No. 

Excel  lent. 

NO. 

NO. 

NO. 

Recovered. 

NO. 

re.. 

Hen,.,,goo.i. 

' 

Uorch  30,  1878. 

20 

Living  iniaST. 
Has  an  abdominal 

» 

"Aug.     31,1878. 

- 

No. 

.b?S». 

™- 

„           - 

« 

Sopl.     17,  1818. 

00 

NO. 

Unknown. 

.. 

aept.     20,  1878. 

34 

TC. 

X.O. 

Odg. 

— 

NO. 

" 

Nov.       8,  1878. 

■-48 

Dnlloculor       •• 

No. 

S,„.,e. 

Died. 

after  operation. 

Doc.      28,  1878. 
Ifob.      IS,  1879. 
Mnroh     0,  1870. 
Miiy      11,  1870. 
Juno      20,  1870. 
July      10,  1870. 
Oct.         1,  1870. 
Nov.      28,  1870. 
Dec.      21,  1870. 

2J 

Fapllloma. 

Multiloeular  cyat. 

Dnilociilar 
ilult.  &  dermoid. 

Eieht. 
Right. 
Left. 

No. 
Yc. 

One. 

No. 

Biuglo. 
Single. 

-■ 

Poor. 

Excellent. 

Died. 

Recovered. 

NO. 

Died,  Jaly,  1870. 
Cunoer  of  lungs 

r/ulou*  Only  one 

. 

1«.        8,18,0. 

30 

Right.           1 

(TwiDB.) 

M.„,... 

NO. 

j^ed  that  patients  have  no 


lealth  since. 


Good. 


Fibroid  seen  at 
Operation. 


]sro. 


Yes. 


No. 


Yes. 


Fibroid 
at  Opi 


No. 


Tea. 


No. 


Antiseptic  ovariotomies.     Carbolic  Ac 

d  Spraj  used.     Sixth 

ovariotomy  the  first  antiseptic  one.     When  it  is  not  stated  that  patients  have  not  answered, 

or  have  died,  it 

is  Imown  that  they  are  ahve. 

»„. 

Date  of 
Operation. 

Age. 

K«„,T.„=,. 

Which  Ovary. 

— • 

Children  before. 

CWldren  sincG. 

Married  or  Single 

SL°.' 

Rupture. 

Llgaturea  heard 

Health  since. 

Opemiion. 

Fibroid  removed 
ai  Operation. 

Twiflled  pedicle. 

Rceult. 

Drainage. 

Adhefllona. 

DciKheubecquenl- 

. 

- 

Unilocular     cyst. 

Broad  ligament. 

Tes. 

Four. 

M„«ea. 

Short. 

"»• 

No. 

--■ 

No. 

... 

Recovered. 

... 

No. 

. 

March  23,  1880. 

3, 

Left. 

... 

Three. 

Long. 

V... 

V... 

never  appeared 

» 

April      1,  1880. 

,S 

Tea. 

... 

Single. 

... 

K 

April     17,  1880. 

« 

... 

.... 

M.„l.. 

S.„l. 

.... 

■■ 

IS 

April     20,  1830. 
iray      18,  1B80. 
July      10,  1880. 
Jnly      15,  1880. 

3. 

Multilocnlar     " 

Left. 
Broad  ligament. 

So. 

.... 

Shiglo. 

Married. 

Single. 

Long. 

■• 

... 

Died,  in  1881,  of 

. 

Jnly      31,  1880. 
Aug.       1,  1880. 
Aug.     21,  1880. 
Aug.     22,  1880. 
Sept.       1,  1880. 
Sept.       2.  1880. 
Sept.       7,  leSO. 

46 

Multiiocular     " 
Dermoid           " 

Papilloma 

Right. 
Right. 

No. 

x™. 

No. 

arrid 
Single. 

Yes. 

Recovered. 

No. 
Yes. 

operatloD. 

Died,  four  daj'H 
after  operation. 

Died,  June,  lesi. 

. 

Sept.     23,  1880. 

33 

M„U„.™,„.., 

.„. 

Six. 

Girl,  1881. 

„.„,.. 

No„.wer.' 

.0..0... 

... 

ITuanotanswercd. 

^ted  that  patients  have  no 


No. 


49 


[ealth  since. 


Good. 


aood. 


esumed  to  be 
sood. 


Poor. 


btter  than  be- 
Ire,  except  for 
-^eart  disease. 


Good. 


Fibroid  seen  at 
Operation. 


Not  known. 


No. 


Yes. 


No. 


Yes. 


No. 


Fibroid  ; 
at  Ope 


N 


Antiseptic 

ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  the  first 

antiseptic 

one.     Wlien  it  is  not  stated  that 

patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  ahve. 

... 

Operation. 

.... 

KMO.T,,™,. 

m.ho™y. 

Catamenia  Bince, 

Children  before. 

omm™..™. 

Married  or  Single 

¥SL°.' 

Rupture. 

Ligatures  heard 

Health  Bince. 

Fihrold  seen  at 
Operation. 

nl  Upcralion. 

Twisted  pedicle. 

■^..t. 

.„,.... 

A....,o... 

'''ram.'.™'' 

38 

Oct.         1,  1880. 

43 

lluUilocular  cyai 

Eight. 

Not  aUBwored. 

Single. 

Nottnowo. 

Not  known. 

Not  known. 

«"'"— 

.0. 

... 

Recovered, 

... 

Y... 

3, 

Oe.        CS... 

38 

Unilocular        " 

Irregular. 

Three. 

w... 

.„. 

No. 

«... 

.0. 

■• 

40 

NOV.        .,,880. 

31 

«ul....™o,.. 

: 

Irregular  and 

No. 

No. 

Married. 

■ij      " 

,: 

" 

No. 

42 

Deo.      18,  1880. 
Dec.      21,  18S0. 
Jau.        6,  1831. 
Ji.n.  .  26,  1881. 

April      S,  1881. 
April     14,  1881. 
April     m,  18S1. 
April     17,  18S1. 

38 

Multilocular  cyat. 

Kigbt. 

Right. 
Right. 

DiseaeedTiidneyB 

after  operalipu, 
EryBipeliisofface. 

Ulcd  of  op  era  Li  on. 

Three. 

/SS- 

Single. 
Single. 

Single. 

3i       ■' 

Long. 
Long, 

... 

No. 

Poor. 
foa-,°ex<;elH  for 

Good. 

YeB. 

.... 

„.„„... 

No. 

only  pit'iixmt. 
FiicKil   Erj'siiK'laa 

Died,  May,  ISSl. 

1 

yted  that 

Datients  have  n 

ro. 

lealth  since. 

Fibroid  seen  at 
Operation. 

Fibro 
atO 

54 

bt  good, — fair. 

No. 

)5 

Good. 

" 

)6 

Poor. 

" 

)7 

Good. 

" 

)8 

1 

" 

9 

i 

« 

0 

i 

" 

1 

Poor. 

-« 

2 

Good. 

" 

3 

" 

" 

4 

K 

« 

5 

« 

Yes. 

6 

" 

No. 

7 

8 

No. 

9 

" 

Yes. 

Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixtl 

ovariotomy  the  first  antiseptic  one.     When  it  is  not  stated  that 

)atients  liave  not  answered, 

or  have  died,  it 

is  known  that  they  are  alive. 

No. 

0?So'n. 

Age. 

K1..o.T™o,. 

™*-- 

— "• 

Children  before. 

--»-• 

Married  or  Single. 

\SL°! 

Rupture. 

"^■;»:"-' 

Healtli  since. 

OpeniiioQ. 

"ro'pV™s.T^ 

Twiatcd  pedicle. 

K0.O,.. 

Dminage. 

Aa.o.,0... 

DeatiiBubaoquent- 

. 

May        5,  1881. 
May      22,  1881. 

3, 

Multilocnlar  cyat. 

Rieht. 

.0. 

NO. 

No. 

Not  good, — fait. 
Good. 

No. 

'. 

....... 

No. 

No. 

Dled,  Jan.,  1886. 

S. 

May      26,1881. 

42 

" 

Two. 

Married. 

,      „ 

Poor. 

Yo.. 

" 

a»=       1,1881. 

" 

UDiloeolar 

L.... 

Ye.. 

Widow. 
Married  again. 

4i       " 

Good. 

■■ 

NO. 

. 

.2 

CyBt. 

No. 

"SS"' 

S..„. 

. 

81 

-"«■ 

" 

■' 

.. 

1. 

.... 

NO. 

Sfngle. 

4         .. 

■■ 

Yo.. 

.. 

Juno     30,  18B1. 

88 

a.„o„a. 

NO. 

" 

W.o„. 

a       .. 

POO,. 

■■ 

NO. 

™i=r°' 

,. 

Jaly       7,  1881. 

=. 

Unilocular     cyst. 

brouU  Ugutnent. 

.e.. 

•• 

Single. 

8         .. 

aooa. 

■ 

.3 

July      11,  1891. 

. 

.... 

■• 

No,ao..„ea. 

Ma„.a. 

4         .. 

■■ 

„ 

July      a-j,  1881. 

„ 

Klsbt. 

Bingle. 

8          .. 

■• 

■■ 

.,, 

July      27,  1881. 

« 

BO.. 

NO. 

NO. 

21       ■■ 

TO., 

.. 

Sept.       1,  1881. 

2. 

Broiid  llgamcDt. 

Left. 
Broad  li  game  at. 

No..a.w„.a. 

21       " 

NO. 

" 

■• 

e, 

Sept.       8,  1881. 

28 

Ba™„.        ey.. 

.0,.. 

No. 

SoManto' 

. 

Sept.     n,  1881. 

« 

.„. 

T.eo. 

M.„,.a. 

8          .. 

No. 

K.„™.o.. 

Y... 

00 

Sept.     18,  1881. 

81 

NO. 

NO. 

■ 

W.O.. 

3i        ■■ 

Tea. 

•■ 

Yc». 

■• 

" 

886,  of  Apoplexy. 

ced  that  patients  have  not 


No. 


3alth  since.     |    ^^i^roid  seen  at 
Operation. 


r,  from  Pa- 
ralysis. 


Good. 


No. 


Fibroid  rer 
at  Operat 


No. 


)d  and  poor. 

p  was  a  sinus 
I  upper  part  of 
nd,  througli 
jder,  and  col 
material   was 
ays  passing 


Pair. 


d  for  a  time, 
hen  poor. 


Good. 


Antiseptic 

ovariotomies.     Carbolic  Acid  Spray  used.     SLxth  ovariotomy  the  first 

antiseptic 

one.     When  it 

is  not  stated  that 

patients  have  not  answered, 

or  have  died,  it  is  known  that  they  are  aUve. 

No. 

OpSi?on. 

Age. 

Kind  of  Tuinor. 

Which  Ovary. 

Catameuia  aince. 

Children  before 

»-»-'• 

Married  or  Single 

InoWon". 

Bnptnre. 

Llgat 

.™he„d 

Health  since. 

Fibroid  seen  at 

".'.%V=?- 

T„i..edp 

e:;,^ 

.e..,.. 

Il„..ge. 

AdhcBlona. 

Deftth  subecqnent- 

™ 

Sept.     27,  1881. 

00 

Multllocular  cyst 

Loft. 

-■ 

Hve. 

NO. 

Married. 

NO. 

NO. 

''°"s,?r^- 

NO. 

NO. 

No 

Ueeo.e,.d. 

NO. 

No. 

71 

0..        .1.81. 

« 

„       „ 

Ym,  until  1882, 

Eight. 

7       .. 

■■ 

Good. 

Te.. 

n 

Oct.         6,  18SX. 

.„™.      .. 

Right. 

.... 

.o. 

• 

^i.o.. 

No. 

Bladdor  opened  at 
operaliOD,  sewed 

.. 

Oct.       24,  1S81. 

Nov.      19.  1881. 
Dec.        1,  1831. 

Jw).      30,  1882. 

Murcli  20,  1882. 

April      3,  1882. 
April      4,  1882. 

"LeftOvary. 
MulUlocular  cyst. 

Kife'ht  Ovary. 

Right. 

^otU. 
Right. 

Right. 

Two. 

One. 
One. 

Two. 

Single. 

Single'. 
Single. 

Bingle. 

3i       " 

Long. 

Long. 

No. 
No. 

fromupperpartof 
wound,  through 

Blw;iyB  passing. 

" 

three  duj'8. 

No. 

Nuclena,  a  hair 
Irom  cy.l. 

d  that  patients  have 


Good. 


Died. 


Good. 


Poor. 


Good. 


Fibroid  seen  at 
Operation. 


Yes. 


No. 


Fibi 
at 


Antiseptic  ovariotomies. 

Carbolic  Acid  Spray  used.     Sixth 

ovariotomy  the  fii-st  antiseptic  one.     Wlieu  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it 

is  Imown  that  they  are  alive. 

No. 

Oporulion. 

Age. 

™~- 

™— ■ 

Catamenia  since. 

Children  before. 

Children  since. 

Married  or  SiDi,'le. 

SI".' 

-'■"- 

Ligatures  heard 

H.,..,„.. 

Operation. 

"St:=J' 

Twifltcd  pedicle. 

n...u. 

Drainage. 

Adhesions. 

Death  euhsequeiii- 
lyt^DatoJ,«d 

.3 

April     10,  1S82. 
April     12,  1832. 
April     19,  1682. 
April     20,  1832. 
April     22,  1882. 
April     22,  1882. 
April     23,  1882. 
April     20,  1882. 
Sray        5,  1882. 
May      13,  1882. 
Juno       6,  1882. 

June      22,  1882. 

32 

Dermoid 

UultUocular 
Cy8t. 

Cyst. 
Multilocular 

Unilocular 

cyst. 

Kight. 

Broad  ligament. 
Right. 

Bight. 

Broad  ligament. 

night. 

Left. 

operation. 

One. 

Three. 
Ko. 

XiDc,  mid  seven 
miscarriages. 

No. 
Has  not  answered 

Two. 
bVC  'Sfl!  giri.' 

Stagle. 

Single. 
Married. 

Single. 
Married. 

Single. 

3    inches. 
Long. 

Long. 

Long. 
44  inches. 

Yea. 

■• 

Died. 
Good. 

Poor. 

... 

No. 

No.      ■ 

" 

Died,  April  20. 
Recovered. 

Ve.. 

TCB. 

?if.:Ly^:.s!. 

j^ted  that  patients  have  i 


Health  since. 


ain  in  left  side. 


Good. 


ood,  I  suppose. 


Good. 


Poor. 


Good. 


Died. 


Good. 


Poor. 


Good. 


Fibroid  seen  at 
Operation. 


No. 


Yes. 


No. 


Yes. 


No. 


Fibro 
at  01 


Antisep 


tic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  the  first  antiseptic  one.     WTien  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  alive. 


KJnd  of  Tumor. 


'in°Slon°' 


iaith  since. 


Good. 


d  that  patients  have  not 


Fair. 


Good. 


Fibroid  seen  at     Fibroid  re 
Operation.  at  Opera 


No. 


Yes. 


No. 


Yea. 


No. 


No. 


Yes. 


]       « 


No. 


Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixtli 

ovariotomy  tlie  first  antiseptic  one.     "When  it  is  not  stated  tliat  patients  have  not  answered,  or  have  died,  it 

is  known  that  they  are  aUve. 

Ho. 

Operalion. 

... 

KiDd  of  Tumor. 

"WTiich  Ovnry. 

— •• 

Children  before. 

OhUaren.,.ee. 

Married  or  Single. 

Length  of 
Incision. 

Rupture. 

Ligatures  Jicard 

HeaUh.,ne.. 

Operalion. 

Fibroid  removed 
at  Operation. 

Twisted  pedicle. 

Result. 

Drainage. 

Adhesions. 

Death  subsequent- 

.. 

Nov.      23,  18S2. 
Dec.      30,  1832. 

. 

Uultlloculnr  cyst. 
Faplltoma. 
Unilocular     cyet. 

StultUocular     " 

Right. 

Right. 

No. 
Yc. 

One. 
No. 

No. 

Single. 
Single. 

" 
Long. 

NO. 

Good. 

No. 

Recovered. 

Yea,  slight. 
Yea. 

Operated  on  again 

.» 

Jan.        8,  1883. 
Jan.       20,  1833. 
Jon.      31,  1883. 

April      4,  1883. 
May        2,  1883. 

. 

Dermoid           " 
Multilocular     " 

Cyal  of  left 
broad  ligomcDt. 

Both. 
Right. 

Right. 

Left. 
Right. 

Left. 

Yc.onco.IOmo.. 
ntler  operatioD. 

Ye.. 
No. 

Several. 
One. 

One. 

Three. 

Married. 
Single. 

Single. 

Shor.. 

Ycfl. 

•■ 

" 

YC9. 

No. 
TcB. 
No. 

Died  after  opera 
topping,  5  weclia 

Recovered. 

Yes. 

Died,  May,  1884. 

iated  that 

patients  have  n 

No. 

1 

Health  since. 

Fibroid  seen  at 
Operation. 

Fibrolc 
atOj 

134 

Good. 

No. 

135 

•' 

" 

[136 

" 

" 

137 

'■ 

" 

138 

" 

" 

.  139 

" 

" 

140 

■ 

" 

141 

" 

" 

142 

" 

" 

143 

( 

Yes. 

144 

(           «< 

No. 

145 

<: 

" 

146 

^ood,  till  1884. 

" 

147 

^       Good. 

" 

14--> 

I 

" 

149 

1            « 

" 

Antiseptic 

ovariotomies. 

Carbolic  Acid  Spray  used,     Sist 

1  ovariotomy  the  first  antiseptic 

one.     When  it  is  not  stated  that 

patients  have  not  ans-vvered,  or  have  died,  it  is  known  that  they  are  ahve. 

No. 

Operation. 

Age. 

— — 

Which  Ovary. 

CatameDia  elnco. 

Children  before. 

Childrea  since. 

Married  or  Sioglo 

¥„&.' 

Rupture. 

Ligatures  heard 

Hea,...,oee. 

OperatioD. 

at  Operation. 

T-...p.,.o. 

Result. 

Drainage. 

.d...,.a.. 

Death  sub  sequent- 

1138 

May      17,  1883. 
May      30,  1363. 

July        3,  18B3. 
July      12,  1833. 
July      20,  1883. 
Aug.       1,  1883. 
Aug.       4,  1883. 
Ocl.       10,  1883. 
Oct.       12,  1863. 
Oct.       £5,  1883. 
Nov.      15,  1883. 

20 

UullUoonLr  cy.t 

Papilloma. 
D.rmold         oj«l. 

I'aiiilloma    * 
Multllocular  cy.l. 

Right. 
Right. 

Tea. 

YcB. 

One. 
Two. 

Two. 

DurlDg  growth  of 
cyst,  she  was  prog- 
wan  produced, 

One. 
No. 
Three. 

One.    Girl. 
Aug.,  1886. 

Easy  labors. 
Both  girls'. 

Dec.riSM. 

Both  girls! 

Single. 

Married. 

Married?!)ec.,'S4. 
Married. 

Single. 
Widow. 

Long. 
Short, 

Long. 

Short. 

■' 

Y-ea. 

Not  heard  from. 

No. 

Ye8.    Oct.,  1885. 
Knot  on  pedicle 

Good. 

Ym. 

No. 

Recovered. 

No. 
Yes. 

Died,  Sept.,  ]86e, 
of  Cousumption. 

U, 

Dec.        3,  1883. 

s. 

Left  brond  liga- 
Rleht. 

..,™..3,o.„. 

No. 

Eight. 

Single. 
Widow. 

.0.. 

No. 

A 

ated  that  patients  have 

No. 

Health  since. 

Fibroid  seen  at 
Operation. 

Fib 
at 

150 

Good. 

No. 

151 

" 

152 

" 

153 

" 

" 

154 

" 

" 

155 

" 

" 

156 

" 

Yes. 

157 

No. 

158 

" 

" 

1 

159 

ood,  except  cys- 
titis. 

" 

100 

Good. 

" 

101 

Fair. 

Yes, 

102 

Good. 

No, 

103 

i 

«' 

i 

10+ 

'Good  till  1885. 

" 

i 

165 

Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  tlie  first  antiseptic  one.     "When  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  aHve. 


.. 

Date  of 
OperatioD. 

Age. 

151 

Jan.      10,  1884. 
Joii.      28,  1894. 

25 

1. 

Feb.       20,  18S4. 

38 

.8 

March     8,  1884. 

88 

1« 

March  34,  1884. 

ei 

1. 

April      2,  1884, 

« 

,m 

JU..       7,1881. 

81 

1,.,8 

. 

101 

Juno     14.  1884. 

82 

1. 

4, 

1. 

July        2,  18*1. 

4= 

inl 

July        S,  1884. 

SO 

No.  No. 


jited  that  patients  have 


No. 


Sealth  Bince. 


Fibroid  seen  at     Fibre 
Operation.       ^     at  ( 


Igg      'ot  very  good.    |  No. 


Good. 


171 


173 


oor.    Cousfh. 


175 


Good. 


177 


178 


179 


181 


Yes.  I 


Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  the  iirst  antiseptic 

one.     Wlien  it  is  not 

stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  alive. 

.0. 

Date  of 
Operation. 

Afo. 

K,o..,Tu.o.. 

W.e.O„,y. 

C.o„e....„. 

ChUdren  before. 

Children  since. 

Married  or  Single 

¥.S;.' 

Rupture. 

Ligatures  lieard 

H„,t..iu.e. 

Operation. 

at  Operation. 

Twisted  pedicle. 

Kcult. 

D,a.a... 

Ad...iou.. 

Death  Bubaeq^ient- 

™ 

July      12,  1H84. 

3. 

MuU„oou,„oy.. 

BO.. 

DnUlMjy,^1885. 

NO. 

NO. 

—■ 

-"'■ 

No. 

No. 

Not  very  good. 

No. 

NO. 

NO. 

Recovered. 

.0. 

NO. 

,0, 

July     10,  1884. 

« 

Cancer  of  right 

Right. 

1,,.. 

■■ 

Died. 

Single. 

.oo. 

Died  0.3d  day. 

■■ 

Ye«. 

■OS 

Aug.      18,1884. 

.8 

.u,.„ooo,„oy.. 

NO. 

.,.. 

M„.e.. 

S..„. 

eood. 

aeeovered. 

NO. 

... 

. 

■■ 

■■ 

'■ 

n. 

Bepl.     11,  1884. 
Ocl.         e,  1884. 
Nov.        S,  1884. 

28 

Right. 

Left. 

Left  broad  liga- 

.... 

No. 
Thtoo. 

One.    Boy. 

W.O.. 

Short. 

NO. 

■■ 

" 

NO. 

174 

Nov.     27,  1884. 

27 

..,.. 

" 

No. 

SiOfle. 

^ 

oor.    Cough. 

" 

.:. 

Doo.       3,  1884. 

87 

Unilocular        " 

NO. 

■' 

M„.ie.,. 

1-0.. 

aood. 

Te.. 

m 

42 

Paiwlloinu. 

130.. 

..0. 

..o... 

Me.„„. 

NO. 

■■ 

"' 

4. 

MuU„oeu,.,.y... 

..,.. 

.... 

NO. 

ilarried. 

" 

178 

Dec.      13,  1884. 

3, 

Uuilocular       " 
I'aiiUlomii. 

hroad  lignmcut. 

NO. 

Six. 
One. 

Short. 

, 

Ve.. 

Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  the  fii-st  antiseptic  one.     "When  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  alive. 


Children  before. 


Married  or  Single. 


Fibroid  removec 


ed  that  patients  have  not 


Good. 


Good. 


Fibroid  seen  at 
Operation. 


No. 


Fibroid  re 
at  Open 


No. 


Yes 


Yes. 


Yes. 


No. 


No. 


Yes. 


Yes. 


No. 


No. 


Antiseptic' 

ovariotomies.     Carholio  Acid  Spray  used.     Sixth  ovariotomy  the  first 

antiseptic 

3ne.     Wlien  it  is  not  stated  that 

patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  ahve. 

Ho. 

Date  of 
Operation. 

Age. 

Kind  of  Tumor. 

Which  Ovary. 

Cntamenia  since. 

Children  before. 

Children  aince. 

Married  or  Single. 

Length  of 
InclBion. 

Rupture. 

Ligatures  heard 
from. 

Health  Bhice. 

Operation. 

at  Operation. 

Twiated  pedicle. 

Result. 

Drahiage. 

Adhesions. 

Death  Bubsequcnt. 

ly.    Dale  and 

cauae  of. 

IBS 

May        4,  1885. 

39 

MaUilocuIsr  cyst. 

Left. 

No. 

No. 

No. 

Bhrgle. 

Short. 

No. 

No. 

G-ood  for  srx 
weeka.    Died  of 

No. 

No. 

No. 

Eecovered. 

NO. 

NO. 

Died  of  general 
abdominal  canter 
and  alao  obatruc- 
tiouin  region  of 
pancreas.-  Cancer 
in  Scar.— October 
16, 18S5. 

.« 

May        6,  1885. 

38 

To.. 

" 

Tea. 

Good. 

■■ 

» 

May      11,  1885. 

35 

Multiloculor   cyal 
and  fibroid  of 

Both. 

Five  time.,  .light, 
and  decreasing. 

Married. 

Long. 

Ko. 

.es. 

Yoi. 

Yes. 

Yea. 

» 

June       2,  1885. 

5, 

Unilocular     cyet. 

Le«. 

No. 

Three. 

■ 

Short. 

Now  another  ab- 
dominal tumor. 

No. 

No. 

" 

" 

.         NO. 

No. 

« 

Juno       2,  1885. 

45 

Uultllocular  cyata 

Both. 

Two. 

" 

Good, 

" 

Yea. 

an 

June       6,  1885. 
June     13,  1885. 
June     20,  1885. 

35 

Multllocular   cyal 
and  fibroid  of 

Eight. 

Yes. 

T«». 
No. 

Single. 

" 

Yes. 

Yes. 

" 

No. 

.oa 

July        2,  1885. 

44 

Multllocular  cyst. 

Right. 

One. 

Married. 

Medium. 

•• 

NO. 

NO. 

Yes. 

Ves. 

Yes. 

207 

July      15,  1»85. 

", 

and  fibroid  of 

Left. 

Irregular. 

Short. 

__ 

Yes. 

Yes. 

No. 

No. 

No. 

.» 

July     17,  1885. 
July      22,  1885. 
Sept.       7,  1885. 

40 

nbro-cyst,  right. 
Mult,  cyet,  left. 

Multllocular  cyats 
Papilloma. 

No. 
No. 

Long. 

Short. 

Long. 
Bladder  wounded 

YCB. 

■      No. 

Yea. 

A  remarkable 

211 

Sept.     14,  1885. 

40 

Multllocular  cyet 

Left. 

Two. 

Long. 

NO. 

2,2 

Sept.     30,  1885. 

23 

Papilloma.     Left 
broad  ligament. 

Ves. 

NO. 

Single. 

Short. 

NO. 

Died.Feb.  7,18BC, 

213 

Oct.        5,  1885. 

03 

Multllocular  cyet 

'      No. 

Two. 

Married. 

" 

Yea. 

Yes. 

probably  of  Can- 

cl  that  patients  have 


lalth  since. 


Good. 


Good 

Seatli  from 
inal  obstruc- 
tion. 


Good. 


Fibroid  seen  at     Mb 
Operation.  at 


No. 


Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sistli 

ovariotomy  the  first  antiseptic  one.     Wlien  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it 

is  known  that  they  are  aUve. 

.„. 

o?2il.     i^«- 

Kl.a.,T„„o.. 

Which  Ovary. 

Catamenia  since. 

Children  before. 

Children  since. 

Married  or  Single. 

Length  of 
Incisioo. 

RuptDve. 

Ligatures  beard 

Hi-alth  since. 

Fibroid  seen  at 
Operation. 

Fibroid  removed 
at  Operation. 

Twisted  pedicle." 

.e»l.. 

Drainage. 

Adhesions. 

Death  Bubecquent- 

=u 

Oct.         S,  1SB5. 

18 

dermoid        cyst. 

Lcrt. 

No. 

- 
No. 

No. 

Single. 

Long. 

NO. 

No. 

Poor.   Died. 

NO. 

No. 

Recovered. 

Yes. 

Tea. 

.. 

Oct.       23,  1885. 

33 

MuUiJocular     " 

Both. 

.,ca. 

Short. 

" 

" 

Died  ou  5th  day. 

NO. 

No. 

., 

Oct.       H,  1885. 

10 

jDilociilfLV        " 

Kitrht 
broad  ligumeut. 

217 

Oct.       17,  1885. 

30 

MuItilocnlajcyBte 

Both. 

.0. 

Three. 

Married. 

Long. 

Good. 

Recovered. 

Tea. 

Tea. 

.S 

Oct.       22,  1885. 

30 

cyfli. 

Right. 

Tea. 

So. 

'  Girl'.' 

.. 

Short. 

■■ 

NO. 

NO. 

™ 

20 

„      .. 

One. 

NO. 

- 

Yea. 

.0 

Nov.       0,  1885. 

3. 

■■ 

NO. 

221 

Nov.      23,  1885. 

38 

Dermoid        cyst. 
Muliilocular. 

No. 

Single. 

Long. 

yes. 

222 

Deo.      11,  1885. 

61 

Multilocular  cyBt. 

LC. 

No. 

Ten. 

Married. 

" 

No. 

Good 
till  dcnth  Erom 

Tea. 

Died,  March  22, 

1886,  of  Intestuial 
Obstruction. 
Strangulallon 

through  adhesions 

223 

Dec.        0,  1885. 

« 

Unilocular        " 

Right 
broad  ligament. 

Te.. 

Fonr. 

Short. 

Oood. 

No. 

225 

JaD.         0,  18S0. 
JttD.       14,  18S0. 

38 

Roil  11(1 -c'l  led 
Sareoinii. 

Right 
hroad  ligament. 

Right. 

Died. 

No. 

■ 

Single. 

Long. 

ie<. 

220 

61 

Multilocular  cyel 

" 

No. 

T.O. 

Married. 

Short. 

Recovered. 

Yea. 

« 

Jno.      10,  laSG. 

33 

M„,.„„c„l„c>..t 

.ct. 

Four. 

„        I        „ 

.. 

" 

■■ 

=28 

Jiiii.      27,  1880. 

35 

„             ,. 

Right. 

°°'F°S'e!'*"- 

■■ 

" 

220 

Jnn.      28,  1880. 

62 

twiated  pi>dlclc. 

Left. 

Died. 

No. 

t 

Yes. 
Cyat  dark  oruu- 
berry  or  purple 

Died. 

In  ArticuIoWortis 
at  time  of 
operation. 

stated  that  patients 


_.     ,^,     .  Fibroid  seen  i 

Health  since.     I        Operation. 


No. 


Good. 


Tea. 


Poor. 


No. 


Good. 


Antiseptic  ovariotomies.     Carbolic  Acid  Spray  used.     Sixth  ovariotomy  the  ;flrst 

antiseptic  one.     Wlien  it  is  not  stated  that 

patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  alive. 

.0. 

Date  of 
Operation. 

Age. 

Kind  of  Tumor. 

Wliicb  Ovary. 

Catamcnia  Biitcc. 

Children  before. 

Children  since. 

M„riedo,S,ogie. 

Length  of 
IdcIbiou. 

Rupture. 

Ligatures  Iieard 

Healtli  .Inoe. 

OperatiOD. 

at  Operation. 

Twisted  pedicle. 

Keeoit. 

Drainage. 

AdlieBtona. 

DeatliBubBequent. 
ly.    Date  and 

«0 

Feb.        1,  1886. 

2e 

"STvarle.. 

Both. 

Ha.ootaiiBwereci. 

One.  Miscarriage. 

M„.ed. 

Short. 

No. 

No. 

No. 

Recovered. 

Y'o.. 

Yee. 

231 

Feb.         8,  ISS6. 

Another  operation 

March  5, 1887. 

Dr.  Utley. 

. 

Mullilocular  cyst, 
with  perJtoniliB. 

Left. 

Yes. 

No. 

.0. 

Widow. 

No. 

No. 

POO. 

Tee. 

No. 

233 

Feb.       13,  1886. 
Feb.       15,  1886. 

48 

Mnltllocnlnr  cyat. 

Right. 

No. 

Two. 

" 

Single. 

Long. 

" 

No. 

No. 

J 

234 

Feb.       10,  1886. 

24 

Papilloiua. 

Yos. 

Four. 
No. 

Short. 

: 

No. 

H 

23. 

March  30,  18S6. 
April       1,  1886. 

25 

Mu'ltilouiilnr  cynt. 

Single. 

Long. 
Short. 

No. 

., 

! 

23. 

April       5,  1886. 

3, 

Two. 

•■ 

Ye.. 

230 

April     29,  1886. 

4a 

Papillomii. 

BO.. 

Died. 

No. 

Single. 

Long. 

NO. 

Died. 

Yoe. 

Died.   ObBtructed 

240 

242 

April     22,  1886. 
May      22,  1880. 

42 
26 

MulLilotuliir  cyst. 
Dermoid           " 
Multiloeulur    " 

Elghl. 

Yes. 

No. 
One. 

Married. 
Single. 

Short. 

■■ 

Recovered, 

Cancer  (?)  of 
removed. 

Yee. 

m 

June        7,  1886. 

3, 

Right. 

Two. 

Yea. 

" 

2« 

June       8,  1886. 

23 

No. 

Long. 

.o...iee. 

Poor. 

No. 

" 

Yes. 

«. 

Juno        9,  1886. 

22 

"°o"Sf°om«Dl'l 

Loft. 

Y... 

Tbreo. 

■■ 

No. 

Yc». 

aood. 

•■ 

" 

AiStated  that  patients 


No. 


Health  since.         Kbroid  see 
[        Operatic 


J       Presumed  to  be 
^  good. 


Good. 


No. 


Yes. 


No. 


Fair. 


Good. 


Tes. 


No. 


258 


Antiseptic  ovariotomies.     Cavbolie  Acid  Spray  used.     Sixtli  ovariotomy  the  fii-st  antiseptic  one.     When  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  alive. 


' 

Dato  of 
OperoUoD. 

Age. 

Kind  of  Tumor. 

Wliich  Ovary. 

Catamenia  since. 

Chiidren  before. 

Children  since. 

Married  or  Single. 

^S£^' 

Rupture. 

Ligatures  heard 

Healihelnce. 

Operation. 

Fibroid  removed 
at  Operation. 

Twisted  pedicle. 

Reault. 

Drainage. 

Adhesiona. 

Death  HubBcquent. 

ly.    Date  aud 

cause  of. 

246 

July        7,  1886. 

43 

Multilocular  oyst. 

Right. 

[asQotauBWcred. 

TOO. 

No. 

Married. 

Long. 

No. 

NO. 

Presumed  to  be 
good. 

No. 

No. 

NO. 

Recovered. 

Yee. 

.e.. 

M7 

July        8,  1886. 
July        8,  1886. 
July     27,  1886. 
Sept.       4,  1886. 

56 

Jnilocular        " 
Uulliloculor     " 

Eight. 

No. 

No. 

Binglo. 
Widow. 
Singio. 

Short. 

Good. 

Tea. 
No. 

Tea. 

„      , 

NO. 

No. 

251 

Oct.        9,  1886. 

48 

ront  of  Bladder. 

Died  of  Tetanus. 

Two. 

Married. 

■• 

Died  on  5th  day, 
of  Tetanua. 

252 

Oct.       16,  1886. 

6. 

Uoilocular        " 
1114  lbs. 

Left. 

NO. 

No. 

Single. 

Fair. 

" 

" 

Recovered. 

.e.. 

Died,  April,  18B7. 

.3 

Hoy.     10,  1880. 

43 

Mulliloculnr  cyst, 
dermoid, 
gelatinouB. 

Not  heard  from. 

Long. 

Good. 

Tea. 

Ve.. 

254 

Nov.     20,  1886. 

15 

Mulliloculnr  cyat. 

Shoru 

■■ 

Ho. 

NO. 

25a 

31 

Broad  lieonaeiit. 

Neither. 

YCB. 

Married. 

" 

No. 

266 
257 

Jan.      10,  1887. 
Jau.      18,  1887. 

22 

ilultiloculur  cyst. 
Miiltilocular  cyats 
Multilocular  cyat. 

Both. 

Died. 

One. 

Single. 

Long. 

Short. 
Long. 

Died. 

Yes. 

25, 

Fob.        3,  1887. 

37 

Yea. 

■• 

■• 

Married. 

Short. 

■• 

200 

Fob.        9,  1887. 
FoK      17,  1887. 

30 

"  removed.  ^ 
Both. 

No. 

No. 

Widow. 
Married. 

Long. 

: 

Yea. 

Yea. 
No. 

ied  that  jiatients  have  not 


alth  since. 


Good. 


Filii-oicl  seen  at 
Operation. 


No. 


Fibroid  rei 
at  Opera 


Viitiseptic 

OYaviotoniies.     Carbolic  Acid  Spray  used.     Sixth  ovai-iotomy  the  first 

antiseptic  one.     When  it  is  not  stated  that  patients  have  not  answered,  or  have  died,  it  is  known  that  they  are  ahve. 

Date  of- 
Operatiou. 

Aso. 

Kind  of  Tumor. 

Which  Ovary. 

«.„.„..„». 

Children  before.     Children  since. 

Married  or  Single. 

Sli^!' 

Rupture. 

Ligdtiires  heard 

1   r'l     -1          1 
Health  .iuce.     |     "i™„il'„„. 

at  Operutiou. 

TwHted  pedicle. 

Result. 

Drainage. 

.dhCOU.. 

Death  subsequent- 
ly.^^DiUe^^and 

62 

Fob.      10,  1887. 

80 

M„lU,ocu,«r.y.,. 

Left, 

and  Hterus  also 

removed. 

K.. 

No.             ;             No. 

Single. 

Long. 

No. 

NO. 

Good. 

No. 

'no. 

Ye.. 

Kecovered. 

Ye.. 

Y... 

es 

Feb.       23,  1S87. 

« 

Jnllocular        " 

T.eft 
broad  ligament. 

Two. 

Married. 

Shorl. 

" 

■■ 

NO. 

No. 

No. 

« 

Feb.      25,  1887. 

57 

MuUilocularcysU 

B..„. 

r-our. 

Long. 

Died. 

Ye.. 

Ye.. 

» 

Feb.       26,  1837. 

23 

Unilocular     cyst. 

Loa. 

Died. 

Three. 

Short. 

No. 

6. 

Feb.       27,  1887. 

61 

" 

No. 

S.. 

Long. 

" 

Keeovered. 

«, 

March   28,  1887. 

48 

Oermoid           " 

Kighl. 

■• 

TWO. 

6, 

March  30,  1887. 

55 

Multilocular     " 

Left. 

P„„r. 

Died. 

Ye.. 

., 

April     11,  1887. 

40 

B„U.. 

NO. 

Binfle. 

Short. 

Recovered. 

No. 

7. 

April     14,  1887. 

23 

left. 

re.. 

Married. 

., 

No. 

" 

April     18,  18S7. 

0. 

Multiloeulart^yHtH 

broad  ligament. 

«„. 

Five. 

Widow. 

■■ 

Yes. 

» 

April     1«,  18S7. 

44 

Mnitiiccuiarcyst. 

Right. 

Ye.. 

Three. 

Married. 

U 

May        2,  1887. 

" 

N„U,e.,,Hro,„. 

one. 

" 

m 

May         5,  18S7. 

53 

Left. 

No. 

No. 

Single. 

■■ 

■■ 

No. 

2!? 

Slay       10,  1897. 
May       11,  1887. 
May       12,  1887. 

: 

"' •" ; 

Rigbl. 

No. 

one. 

Married. 

•■  <?) 

Yc. 
No. 

Ye.. 
No. 
Ye.. 

Died,  18th  day,  of 
Pulmonary 
Embolism. 

.a 

May      16,  18S7. 

33 

Multilocular     " 

L.«. 

To.. 

NO. 

Single. 

" 

After  nearly  four 

270 

May       20,  18S7. 

28 

Right. 

One. 

Married. 

"  (?) 

pulec  and  temper- 
cntly  of  iudlgea- 

1 

280 

J„„a       8,™t. 

53 

Colloid  tiimorB. 

IJoth. 

No. 

Eight. 

No. 

tion. 

281 

June      30,  1857. 

35 

Multilocular  cyst 

Ye.. 

NO. 

Single. 

" 

282 

July        7,  1887. 

45 

Papilloma. 

Three. 

Married. 

.. 

Ym. 

1 

's  by  Laparotomy 


No. 


Pd 


Adhesions. 


No. 


Tes. 


No. 


Tes. 


No. 


Tes. 


and 


No. 


Hysterectomies  and 

removal  of 

Uterine  Tumors 

)y  Laparotomy. 

Ko. 

Ago. 

Date. 

Kind  of  Tumor. 

Catamenia  since. 

Children  befo 

re.      Married  or  Single. 

Ine,.,on. 

Rupture. 

Treatment  of  Pedicle. 

AdlieBione. 

Health. 

Cauae  of  Death. 

Draiu  age- 

Wei.^ht  of 

Result. 

Remarks. 

' 

40 

April 
Moy 

S,  1881. 
n,  1882. 

Myon.«. 
Fibro-cyat  and  botb  ovaries 

Died. 

No. 

Single. 

Long. 

Unltnown. 

Intra-peritoneal.      Tied  and 
cauterized. 

Intra-peritoneal.  Tied  aud  burnt. 

No. 

Good. 

Debility. 

No. 

U  Iba. 

Recovered. 
Died. 

= 

.. 

April 

11,1833. 

Two-horocd  uteruB  filled  with 
bloody  fluid. 

No. 

■■ 

" 

No. 

Estra-peritoneal.    Tied  with 
Bilk  aud  kept  oulaide. 

No. 

Good. 

neeovered. 

^ 

« 

April 

24,  1883. 

Fibro.n.yo.a. 

Died. 

six. 

" 

Extra-peritoneal.     Clamp. 

Tee. 

Died. 

septicemia. 

Died. 

44 

Oct. 
Nov. 

3,  1883. 

No. 

j            Single. 

I 

Married. 

Intra-peritoneal.    Tied. 
Intra-peritoneal. 

" 

Shock 

" 

8   lbs. 

: 

52 

June 

12,  188). 
23,  1884. 

Fibroid. 

„ 

Yea. 
No. 

Extra-peritoneal.     Ktcberle'e 
eerre-ncuud. 

Intra-peritoneal.     Tied. 

No. 

Good. 

2S   " 

Recovered. 

■' 

. 

Aug. 

0,  1884. 

Fibro-myoma. 

Died. 

Single. 

Extra-periConeal.    Koeberle's 

Died. 

Septieiemia. 

71  lbs. 

Bled. 

,. 

. 

B.O. 

6,1884. 

Fibre -myoraatoiie  cyst. 

Yes. 

■■ 

Intra-peritoneal.  Tied  and  burut. 

.e.. 

Good. 

" 

3i   " 

Recovered. 

. 

60 

Fob. 
Fab. 
April 

June 
July 

5,  1885. 

14,  1885. 
20,  1885. 

15,  1885. 

Fibro-myoma. 

Myoma. 

Fibro-myoma. 

Fibroid.    Ovuriea  uystlc  also. 

Fibroid  and  un  ovury  cyalic. 

Fibroid. 

Died. 

Irregular. 
Tea. 

Ono. 

Married. 

Single. 
Married. 

Single. 
Married. 

Short. 
Long. 

Extra-peritoueal.    Kosberie'a 
Berre-uojud. 

Intra-peritoneal.     Ligature   and 
WMitery. 

Extra-pcritoneiil.     KiDbcrlc'i) 
Intra-peritoneal,     Tied. 

Extra-peritoneal.    Kceberle's 
aerre-utcud. 

No. 

Died. 
Good. 

nasmorrhnge. 

Tea. 

No. 

Tea. 

i 

8     ■■ 
Small. 

4 

Died. 

s  by  Laj^arotomy 


Ko. 


IK 


lis, 


Yes. 


No. 


Ko. 


Ilk, 


Yes. 


No. 


Hysterectomies  and 

removal  of  Uterine  Tumors 

by  Laparotomy- 

Ko. 

Age. 

Dale. 

K..„,T™o,. 

Catanieiiia  since. 

Children  before. 

Miirpcd  or  Single. 

ineieion. 

Rupture. 

Treatment  of  Pedicle. 

Adheeloue. 

Health. 

Cause  of  Death. 

Drainage. 

Weight  of 

Result. 

Remarks. 

. 

!» 

Sept.        18 

1885. 

llyxo -fibroma. 

No. 

.0. 

Siogle. 

- 

NO. 

Exlra.peritoueal.    Kiuberle's 
serre-nieud. 

NO. 

Oood. 

No. 

.... 

Recovered. 

IS 

45 

Feb.          22 

«8.. 

Fibro-myomn. 

l^ied. 

Extra-peritoneal. 

Excellent. 

PeritoniliB.     Ulceration 

of  the  ccceal  valve, 
pelvic  abscees. 
Death,  27th  day. 

fl  iDChee  of 
uterine 
cavity. 

IG    lbs. 

Died. 

20 

48 

Oct.             6 

1886. 

Fibro-mysoma. 

So. 

Sli. 

Married. 

No. 

Tea. 

Excellent. 

No  peritonitis.    Death 

Recovered. 

. 

. 

Jau.          11 

188. 

ibro-myoraa. 

"" 

Ooe. 

Died. 

No. 

Died. 

logical  shock,  ap- 
parently. 

6 

Died. 

. 

4, 

,„.          22 

1887. 

No. 

Single. 

No. 

Estra-peritonenl,  including  a 
piece  of  tbe  bladder. 

" 

Good. 

=... 

.ee.„red. 

A  portion  of  bladder  was 
included  in  serre-nomd 

. 

,2 

...            , 

18S,. 

.„™...™. 

One. 

Widow. 

Extra-peritoncjil,  tied  with  silk, 
and  held  outside  with  a  pin. 

Tei. 

Tea. 

Incorpora- 
ted with  left 

ovary. 

Ventral  hernia  cured  at 

« 

Fob.         12 

1887. 

Fibro-myoma. 

Three. 

Morrled. 

Extra-peritoueal, 

No. 

No. 

7.h.. 

. 

™ 

...       :. 

1887. 

Ulerua  incorporated  in  an 
Ovariuii  Tumor. 

•■ 

No. 

Single. 

■• 

Extra-peritoneal,  lied  with  eilii, 

.e.. 

Tes. 

Inosrpora- 

teri  with  left 

ovary. 

Twisted  pedicle. 

» 

3» 

March      18 

1887. 

»"-™»; 

■■ 

Extra -peritoneal.  Pelvic  portion 
of  Tumor  loft  behind. 

Obatmction  of  ureters 
by  wire. 

NO. 

.lbs. 

Died. 

2, 

48 

April        29 

1887, 

No. 

■• 

Extra.peritoneal. 

No. 

Recovered. 

Qe  and  Ovarian  Tumo] 


R    E    M    A    ] 


s.    Xo  Autopsy. 


icer  removed. 


lis  of  Tumor  Isrought  outside  and  held  t 


plum  removed.    Died  some  years  later. 


3  Omentum  for  Diagnosis. 


topsy. 


lit  Ovary. 


Laparotomies. 

Attempted  and  Partial  Removal  of  Uterine  and  Ovarian  Tumors 

"ko. 

Dale. 

Age. 

Caiiae  of  OperaUon. 

Result.       . 

R    E    M    A    R 

K  e  . 

' 

FBb.            3,  18S0. 

a, 

ABciU'S  and  Sarcoinatous  Ovaries. 

Died. 

Died  on  the  10th  day.    Dlaeascd  Kidneys  and  probably  Peritoniiia.    No  Autopsy. 

2 

Juno        U,  1881. 

" 

Sarcoma  of  Omentum,  Srcnoutery  and  Pelvic  OrganB, 

B,.o,.oe..oa....™.    AW13...o,Bacep.,o.Ca„e„„„ovo.. 

= 

July         13,  ISSl. 

50 

Utor]in;Fihro.cyat, 

Cyst  emptied  and  wails  sewed  up  and  dropped  back. 

. 

f 

* 

xov.       .:,«a,. 

33 

Cyst  emptied.    lOJ  lbs.  solid  matter  removed.    Cyst  walls  and  wu 

lis  of  Tumor  brought  outside  and  held  by 

Steel  Sound. 

:> 

Dbc.         29,  I»81. 

30 

Recovered 

Cyst  emptied.    14  lbs.  fluid  removed.    Another  Fibroid  size  of  a 

)lum  removed.    Died  some  years  later. 

» 

Feb.         10,  1882. 

5. 

Solid  Sarcoma  or  Cancer  of  IFterue,  Ovaries,  Bowels,  and  Pelvic  com.iHa. 

Died. 

S,.oe..o...a.,.ao.o„,.«o.ope.„o„. 

May           6,  1882. 

.2 

Attcitcs  and  Cyelic  Tumor  in  Pelvia. 

Cysta  (small)  punctured.    Uterus  involved  in  Tumor. 

» 

Aue-         ^.  1882. 

3, 

Adherent  Ovurian  Cyst. 

Nothing  removed. 

« 

SEpl.        11,  1882. 

62 

Fibro-cystof  Uterus. 

Portion  of  Tumor  (7  lbs.)  removed. 

,0 

S.P1.        21,1882. 

62 

Adherent  Ovarian  Tumors. 

Ascitic  and  Ovarian  fluid  removed  and  a  portion  of  Cysts. 

" 

Nov.         15,  1882. 

20 

Cancer  of  OvaricB  and  Peritoneal  OryaEs. 

One  Ovary  removed ;  and  Ascitic  fluid  and  a  portion  of  Caneeroua  Omentum  for  Diagnosis. 

,. 

April        21,  1883. 

30 

Aecitea  and  General  Abdominal  Cancer. 

Probably  growth  originally,  Papilloma  of  Ovaries. 

13 

May          21,  1883. 

38 

Fibroid  of  Uterus,  and  Tumor  of  both  Broad  Ligaments  and  Uterui^. 

Cysts  and  fluid  removed,  partially. 

„ 

July         10,  1883. 

« 

Tumor  filled  with  pus,  adherent  to  Bowels,  small  and  large,  and  Pelvis. 

Probably  a  Salpingitis.    Died  in  Convulsions  in  34  hours.    No  Autopsy. 

U 

Nov.         27,  1883. 

48 

Cystic  Fibro-myoraa  and  Ovari.tn. 

P.„,a,„,oova,„l..e™.aa.  10  ...„.»„.. 

u 

Oct.          IS,  1881. 

6. 

General  Abdominal  Cancer.    Originally,  perhaps.  Ovarian. 

Tweuly-tive  pounds  of  fluid  removed.                                                                                 ' 

" 

May           7,  1886. 

« 

Uterua  tilled  and  covered  with  Fibro -myomatous  Tumoru. 

A  sebaceous  mass  removed,  and  probably  more  or  less  of  the  Right  Ovaiy. 

3d  to  sMn. 


,  of  Cancer  of  liver  and  uterus. 


L885. 


It  pui-ulent  discharge  in  1887. 


R    E 


ther  disorders. 


R    E 


moved  in  1S77,  on  account  of  cj-sti 


ied  soon  afterward. 


n  adult  foJtus  removed.     Specimei 


Laparotomies  for  Ovarian  Cysts,  stltclied  to  sldn. 


No. 

pa... 

Age. 

Cuuee  of  Operation. 

Kbsult. 

REMARKS. 

1 
4 

July         18,  1883. 
March        i,  1884. 
Aug.         la,  1884. 
Oct.            6,  1884. 

as 

AdhercDt  cyet,  origin  probitbly  ovariuii,  inseparable. 

Tumor  puocliirctl.    Oviirian,  probably. 

Turaor  probably  ovariau,  or  of  broad  liBiuncut,  aud  tubercular.    Peritonitie. 

Cyat  of  riflit  broad  ligameiit. 

Recovered. 

Tumor  stitched  to  skin,  and  drained.    Died  subsequently,  of  Cancer  ol 
Tumor  stitched  to  sldn,  and  drained.    Died  of  Phthisis,  1885. 

,.e.an.U,.e™,. 

6 

June        12,  1885. 

3, 

Multiloculur  ovarian  cyst,  — adherent. 

Cyst  stitched  to  skin,  and  drained.    Well,  except  forsliglit  purulent  dis 

T 

May          25,  1880. 

41 

CysiH  of  botli  ovarieg.    Left,  ndhe'rent  aod  inseparable. 

Cyst  stitched  to  skin,  and  drained.     Perfectly  well  in  188T. 

' 

June          3,  1880. 

40C?) 

Jliihilocnlar  ovarian  adherent  cyet,  with  thick  walls. 

Cyst  stitched  to  skin,  and  drained.     Perfectly  well  in  18S7. 

Lai^ar 

otomies  for  Cysts  complicated  with  otlier  disorders.    . 

No. 

Date. 

Age. 

Cause  of  Operation. 

Resuit. 

R    E    M    A    R 

K    S  . 

- 

July           3 

is™. 

45 

Uterine  fibro-cyst. 

Died. 

Walls  of  cyst  stitched  to  skin.     Both  ovaries  had  been  removed  in  1877,  on  account  of  cys 

—■ 

2 

Oct.         n 

1882. 

. 

Uterine  fibro-myomatous  cyst,  and  ovarian  cyst. 

Ovarian  Tumor  removed.    Uterine  cyst  stitched  to  akin. 

3 

Aug.          1 

1883. 

42 

Tumor  probably  ovarian,  but  exact  nature  unknown.    Alraosl  eulid. 

Recovered. 

.o™„...e.  .0  ..o,  an,,  .™,„e..    ..e,.  .„„»,  .u...  .oou  a«e™a,a. 

^ 

Sept.         20 

1883. 

A.OU, 

Bomi-solid  Tumor  attached  to  bladder  and  all  neighboring  organs. 
Probably  ovarian,  originally. 

Died. 

Tumor  stitched  to  skin,  and  drained. 

„ 

March 
June 

,  1880. 

35 

Cyst  of  extra-uterine  prcgniincy,  seven  years  old. 

Cyat  Btitclicd  lo  skin,  and  drained.    Ali  Ibe  skeleton  of  au  adult  fuTtus  removed.    Specim 
Cyat  Btitclied  to  skin,  aud  drained.     Died  of  shock  and  Peritonitis. 

u  in  Warren 

Museum  of  H 

arvard  College. 

9 

' 

April 

,188,. 

45 

Adherent  Tubo-oviirian  cyst.    Fibro-myomii.    Hydro -salpinx. 

Cyst  stitched  to  skin,  aud  drained.    Died  of  Acute  Peritonitis. 

jsy,  the  Tumors  were  found  to  be  ir 


lominal  tappings. 


R    E    3J 


me,  better  than  for  many  years.    M 


jvable. 


Vent  home  well  and  strong 


Exploratory  Laparotomies. 


KO. 

Pntc  of 
OiieralioD. 

Ago. 

Cause  of  Operation. 

Result. 

- 

E    M    A    R    K    S  . 

, 

Dec.         12,  1S7S. 

02 

Iteeoverea. 

T,.ea.c„o.nev.„eeu„ea.S.ea..ayoa,.«o.vard.. 

= 

Feb.          22,  1881. 

48 

Papillomntous  adherent  Tumors  and  ascites. 

Died  eight  months  later,  September  9, 1SS2.    At  the  autopsy,  the  Tumors  were  found  t 

bo  irremovable. 

3 

Aug.        18,  18S1. 

80 

Solid  sarcoma,  probsibly  not  cystic.    So  adherent  as  to  be  immovaljje,  and 
originally,  ovurJLm.     tiome  ascites. 

Died  a  year  or  two  later. 

' 

Sept.        22,  1S81. 

21 

Ascites,  and  pelvic  Tumor,  immovable. 

Tumor  is  said  to  have  disappeared  in  ISSiJ,  after  many  abdominal  tappings. 

^ 

Sept.        20,  1S82. 

8, 

Ascites,  and  general  abdominat  Cancer. 

Died,  March  19, 1883,  six  months  after  Laparotomy. 

« 

May           a,  1883. 

84 

ABcites,  and  general  abdominal  Cancer. 

l.t.ou.M.o.avo.,eaa.ou.,.„o„ou...,a..,. 

Aug.          0,  1888. 

00 

Ascites,  and  general  abdominal  Cancer. 

Died. 

In  three  days,  died  of  Peritonitis. 

. 

March      22,  1881. 

.0 

Ascites,  and  general  abdominal  Cancer. 

Recovered. 

Blea  about  ..™„n...  MO. 

« 

Juno         13,  1884. 

" 

Tubercular  salpingitis  and  cheesy  deposits  in  abdomen,  of  tubular  and 
tubercular  origin. 

B,0U. 

Death  from  Peritonitis,  on  third  day. 

,0 

Juno         1!),  1884. 

21 

Tubercular  peritonitis. 

liccovered. 

Fat  and  well  in  1SS6.    Married.    Has  gained  thirty  pounds. 

" 

Jan.           8.  1885. 

40 

Canoo..,„na.„o„,„a,v,.ee..    A.eH0.an..„a,ua.e. 

Death,  six  months  later. 

12 

July          0,  1885. 

10 

Canterous  abdominal  Tumor,  of  unknown  origin. 

Died,  May  1, 1880,  nine  months  after  Laparotomy. 

" 

H 

Nov.         20,  1885 

Cancer  of  omentum,  probably.     Ascites. 

" 

Iticd  of  Pneumonia,  March  13, 1SS6.    Health,  up  to  that  time,  better  than  for  many  year 

.    Much  benefited  by  operation. 

. 

„ 

Feb.         10,  1886 

Enbirged  uterus,  and  apparent  Tumor  in  left  iliac  region. 

Ko™.ova..Tu„o,.oun.. 

U 

KOV.            2,18Se 

05 

Tumor  in  right  iliac  region. 

Tumor  involving  and  including  small  intestine,  — not  removable. 

,« 

Nov.          13,  1880 

5. 

General  abdominal  Cancer. 

Drainage.    A.e,..e  «u.  renrovo.    D,e.  .ou.o  „ou.b.  later. 

- 

Feb.           10,  1S&7 

08 

— ■>— ■ 

Went  home  well.    Not  since  heard  from. 

n 

Feb.         22,  1887 

55 

Abdominal  Tumor. 

Septic  PeritonittB. 

Ovariotomy,  si.^i  years  before. 

10 

April         30,  1887 

17 

AscitCB.    Tubercular  peritonitis.    Ovary  and  tube  removed  for  diagnosis. 

Kc  covered. 

Drainage.    Prof.  FiTZ  reported  the  disease  tubercular.    Went  home  well  and  strong. 

I 


ge :  —  Three  cures. 


r.    Her  monthly  sickness  has  been 


lylum  about  1S71.    The  resources  of 


7  lost  than  before  operation. 


tter  to  have  removed  the  uterus. 
t  of  the  abdomen.      Subsequently 


r  December  20,  1886,  and  patient's 


One  cure.     Four, 


manent  Improvement,  thovigh  the  ] 


Goldsmith  in  American  Journal  o 


lum,  of  Phthisis,  1886. 


Dre  operation.      Catamenia  painful. 


before  operation. 


Jan.  21,  18811. 


Five  cases  of  removal  of  Uterine  Appendages  for  the  cure  of  Uterine  Haemorrhage :  —  Three  ciires.     One  no  improvement.     One  death. 


myoma  and  McnBtnial  Insanity. 


Profuse  Bleeding  from  Fibro-myooia. 


Profuae  Bleeding  from  Fibro-myoma. 


Catamcnia  since. 


T'lowing  slightly 


roucb  of  the 

ceased 


Flowed   for  five 
weeks.    Now  cat- 


Exceesive  Flowing 


RPHiilt  Recovery 


Perfect  recovery. 

appeared,  and  the 
paticDt  is  happy 
and  overjoyed    at 


No  improvement. 


Recov'd  from 


■  REMARK 


laller.    Her  monthly  siclineBs  hne  been  lees  than  before  opernlion,  but  a  r 


leaking  of  blood  till  June, 


111  Worcester  iDsane  Asylum  about  1S71.    The  resources  of  the  town  where  she  lived  had  teen  exhausted  in  attempts  to  restrain  and  control  her  during  her  menstrual  periodg. 


It  would  have  been  better  to  have  removed  the  uterus.    The  tumor  was  a  large,  wet,  spongy  fibro-myoma,  and  t 
pulled  out  of  the  abdomen.      Subsequently  the  tumor  was  stuffed  back. 


Tumor  somewhat  larger  December  20,  1S88,  and  patient's  condit 


r  the  tumor  had  beefl 


Five  cases  of  removal  of  Uterine  Appendages  for  IN'ervons  Disorders.     One  enre. 

Four,  no  great  hnprovement. 

Ho. 

Date. 

Age. 

Cause  of  Operation. 

Catamcuia  since. 

Result. 

DeatL. 

UBMA.KS. 

> 

. 

Hysteromania. 

No. 

Much    improve- 

Recovered. 

I  think  there  is  do  permanent  improvement 

though  the  patient  states  that  there  is. 

' 

July          20,  1S83. 

1» 

Moral  Insanity,      Operation   done  at  Danvers  Insane  Asylum. 

Complete  relief. 
Perfectly  well. 

Case   reported  by  Dr.  Goldsmith  in  Ameri 

an  Journal  of  Insanity,  October,  1SB3. 

' 

...          .3,^3. 

. 

Mania.    {Chronic.) 

No  improvement 

B,.a.Wo„e.,„A.„..,o.P....,.,18 

,. 

• 

AUB.         M,  1885. 

35 

Severe  pain  in  left  ovarian  region,  causing  nenous  symptoms. 

Tes.    Regular. 

No  great  improve- 

About  the  same  as  before  operation.      Cata 

uenia  painful. 

^ 

Sov.         25,  188S. 

Pain,  Nervous  Excitement,  and  Hystero-Epilepay. 

Yes. 

No  great  improve- 

The  same  condition  as  before  operation. 

nors.  —  Two  immense 


R    E    M    A    R 


and  the  abdominal  wound,  extending  n 


laining  behind.    Cases  reported  in  "  Boi 


.    Case  reported  in  '•  Boston  Medical  ar 


REM 


vom-out,  feeble  woman.    Stones  remov 


•nal,"  Vol.  ex,  p.  73.     Suppression  of  u 


edical  and  Surgical  Journal." 


Lapai'otomy 

for  other  purj^oses  than  the  removal  of  Abdommal  Tumors.  —  Two  immense  fatty  Timiors. 

No. 

.a.o. 

CouBCOf  operation. 

-""■ 

REMARKS. 

^ 

Oct.           30,  1881. 

Iinracnae  Lipoma.     Ketro -peritoneal.     Patient, 

exploratory. 

man  aged  38.     Operation 

Recovered. 

The  Tumor  was  found  to  be  broadly  attached  behind  the  peritoneum 

and  the  abdominal  wound,  extending  nearly  from  the  Eiisiform  cartiinge  lo  the  Pubea,  was 

o»ca„p. 

" 

Feb.            5,  1882. 

Same  patient,  who  desired  to  Iry  the  oper 

lion  aan  last  resort. 

Died. 

Tumors  removed  weighed  GQ  pouude.    More  myxomatous  tumors  re 

laining  behind.    Cases  reported  in  "  Boston  Medical  and  Surgical  Journal,"  Vol.  cviii,  pp.  3 

and  241. 

Wnreh      21.  1882. 

Patient,  ii  woman  with  a  fluctualhig  Tumor  from 
wlicu  uBpira(«d.    Aged 

whieli  notliing  would  run 

Tumor  removed,  a  rayxo-llpoma  weighhig  35  pouuds,  retro -peritonea 

Case  reported  in  "  Boston  Medical  and  Surgical  Journal,"  Vol.  cviii,  pp.  35  and  241. 

Renal   Tumors. 

No. 

B.O. 

Sex. 

Cause  of  Operation. 

Result. 

REMARKS. 

Recovery  from  the 

April         10.  1882. 

Female. 

itbacees  of  right  Ividney.    Age 

Deatrone  month 

A  case  of  calculous  nephritis  of  long  standing,  in  a  wom-o 

I  outer  bordc 

rof  right  reel 

^ 

Nov.          23,  1883. 

Malo. 

Sareo 

ma  of  left  Kidney.    Aged  29. 

Died. 

Case  reported  in  "  Boston  Medical  and  Surgical  Journal," 

Vol.  ex,  p.  73,     SupprcBBion  of  urine  and  peritoi 

..,.. 

' 

Aug.          1,  1884. 

Female. 

Large  e 

icculiited  Kidney 

right)  lllled  with  pus.    Tumor 
Aged  42. 

weiglictl 

2  pounds. 

Suppression  of  urine.     Case  reported  in  "  Boston  M.dical 

uid  Surgical  Journal." 

t 

strnction. 


Very  comfortable  for  nearly  a  y 


Patient  very  stont.    Weather  ve 


Great  relief  for  a  week.    Case  <^ 


Described  in  text. 


Abscess. 


1887. 


)yaries  and  Tubes. 


R    E    M    A 


t  tube  could  not  be  distinsuished.    Man 


3e  and  uterus  distinguishable. 


Abscess. 


R    E 


f  passing  an  india-rubber  drainage-tube 


Laparotomy  on  account  of 

Intestinal  obstruction. 

K 

Date. 

Age. 

Sox. 

Cause  of  Operation. 

T,.l.e„.. 

Be.„,.. 

REMARKS. 

B.,         ..... 

« 

Female. 

IntCBlmftl  olistniction,  ciinacd  by  Cancer  of  the  df 
months  after  ovariotomy. 

euding  colon,  aeven 

AniBcial  anue  in  pubic  region. 

Recovered. 

Very  corafortnble  for  nearly  a  year.    Died  of  general  abdon 

inal  Cancer,  November,  1 

.. 

July          10,  lSS-2. 

Inteslinal  ol.atri.cliou,  cauaed  l.y  Cancer  of  the  dt^t 
splenic  region. 

ending  colon,  in  the 

Artificial  anus  in  creciil  region. 

Died. 

Patient  very  stout.    Weather  very  hot. 

. 

.....          .,,»«. 

. 

Male. 

Inleetiual  obstnicliou,  cauaed  by  a  baud  from  a  JIo 

.1W,„„,.1U,. 

Artlficiiil  anus  in  umbiliciil  region. 

Great  relief  for  a  week.     Case  described  by  Prof.  FlTZ,  in  t 

lie  "American  Journal  of 

l.e>...,S*,..,..V0,.el„.p.». 

April          3,  ISSa. 

61 

.e..,e, 

Intcatinal  obstruction,  cansed  by  strangulation  of  tiit 
the  cicatrix  of  ovariotomy. 

intesUne  at  the  site  of 

Artificial  anus  at  site  of  old  cicatrbc. 

Described  in  text. 

Laj^arotomy 

on  account 

of  Peri-typlilitic  Abscess. 

.S„. 

Bale. 

Cauaeof  Operation, 

Treatment. 

Result. 

REMARKS. 

' 

Jan 

11,  IS.. 

Peri-typhlitic  abHcesa  and 

peritonitis. 

Lap 

arotomy  in  right  iliolumbar  region. 

Recovered. 

Well  and  hearty  in  1887. 

Laparotomy  for  Pyosalpinx  and  Suppuration  in  Ovaries  and  Tubes. 


1.0. 

Ba,„. 

Ago. 

Cause  of  Oper.illon. 

Keault. 

REMARKS. 

' 

May          21,  3380. 
Doc.           0.  1886. 

22 

Double  pyo-aalpiux  and  abscesHca  iu  both  ovaries  (gonorHxcal]. 
Suppurating  tubo-ovarian  cyst,  with  general  old  pelvic  peritonitis. 

Died. 

Both  ovaries  filled  with  absceeaea,  and  adherent.     The  right  tube  could  not  be  diatinguiebed.     Many  ligatureB  or  rather  many  knots.    Ligature  discharged  seveu  months  later. 
Pelvic  organs  presaed  together,  and  only  right  Fallopian  tube  and  uterua  distinguishable. 

Laparotomy  for  long-standing  Pehdc  Abscess. 

So. 

Date. 

A.e. 

Sex. 

OaufiQ  of  Operation. 

Result. 

B.MAKKS. 

^ 

Aug.        20,  1885. 

,0 

Female. 

Pelvic  Abscess  f 

s  probably  tubercular. 

Recovered. 

Improved  by  operation,  -which  consisted  of  paasing  an  India 

•rubber  drainage-tube  from  the  pnbic  regi 
July  0,  18B0. 

n  through  pelvis  and  rec 

urn,  and  o 

ut  through  the  a 

f  general  tu 

bcrculoslfl 

I 


matures  heard 
from. 


e.,  prior  to  1877 


Health  eince.  Fib 


Ovariotomies  before  the  adoption  of  Listerism: — 

i.  e.,  prior 

to  1877. 

• 

So. 

Date. 

Age. 

Kind  of  Tumor. 

Wblcb  Ovnry. 

CatamenJa  since. 

Children  before. 

Children  alnce. 

tiiui,'le. 

O.SL. 

Rupture. 

Ligaturea  heard 

Health  since. 

™„,..o„. 

Fibroid  removed. 

Twisted  pedicle. 

Geault. 

Drainage. 

Adhesions. 

1 

,8«. 

30  (?) 

Multilobular  cysts. 

Both. 

K„. 

Slhglo. 

.oog. 

No. 

No. 

No. 

Died. 

No. 

Yes. 

^ 

April         24,  1873. 

« 

Multiloeular  cyal. 

Eight. 

■• 

■■ 

3 

Feb.          17.  1874. 

. 

Papillorna. 

Both. 

Married. 

■■ 

■■ 

■■ 

' 

Feb.           18,  1874. 

43 

M„U„„»,„.,.. 

Right. 

» 

■■ 

.» 

May           18,  1875. 

Unilocular       " 

..t. 

Yes. 

Short. 

No. 

Only  one  of   the  above  cases,  the  last,  was  at  all  promising.      I  think  I  could  easily  cure  a  similar 


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